Experiences of Racial and Ethnic Discrimination Are Associated with Food Insecurity and Poor Health

Racial and Ethnic Disparities in Food Insufficiency in Families with Children During the COVID-19 Pandemic: the Role of Risk and Protective Factors

BACKGROUND

Black and Hispanic households are at elevated risk of food insecurity and insufficiency-correlates of adverse outcomes in areas such as health and mental health-relative to White households in the USA. The COVID-19 pandemic and its economic shock threatened to further exacerbate these issues. Research has identified a number of risk and protective factors for food insecurity and insufficiency. These could relate to racial and ethnic disparities in two ways-through aggregate differences in the distribution of characteristics such as educational attainment and employment or through differences in the degree of risk or protection associated with a factor. We examined the relationship between four factors-household head age, educational attainment, single mother household composition, and employment-and disparities in food insufficiency between White, Black, and Hispanic households with children during the COVID-19 pandemic to consider these pathways.

METHODS

We analyzed data from the Census Bureau's Household Pulse Survey using bivariate statistics, multivariable regression, and decomposition methods to understand differences in the prevalence and consequences of underlying risk and protective factors for food insufficiency in households with children.

RESULTS

Consistent with prior literature, we documented higher rates of food insufficiency among Black and Hispanic households compared to White households. Differences in the distributions of education and employment accounted for a substantial fraction of the disparities in risk. Both the distribution and degree of risk associated with single mother household composition also related to disparities, but these differences were muted after accounting for economic resources. Much, though not all, of the relationship between the distributions of education and disparate risk of food insufficiency were also captured by differences in economic resources.

CONCLUSION

This study provides insight into the structure underlying racial and ethnic disparities in food insufficiency during the COVID-19 pandemic, highlighting the importance of human capital, income, and assets.

Maternal adverse childhood experiences and lifetime experiences of racial discrimination: Associations with current household hardships and intergenerational health

Growing evidence shows parents' exposure to adverse childhood experiences (ACEs) and lifetime experiences of racial discrimination (EOD) negatively impacts not only their own health, but also their children's health. ACEs and EOD can be conceptualized as a reflection of shared underlying adversities and structural injustices that manifest in inequitable educational and employment opportunities and differential treatment by public policies and programs that impede parents' capacity to support their families. Therefore, a potentially important, but underexplored, mechanism of effects of parent ACEs and EOD on the next generation is through effects on household material hardships. Using cross-sectional survey data collected from 1629 mothers of young children aged <4 years during pediatric healthcare visits in four US cities (Baltimore, MD; Boston, MA; Little Rock, AR; Philadelphia, PA), we examined individual and joint associations of mothers' ACEs and EOD with their health and their children's health, as well as household-level material hardships. In demographics-adjusted Poisson and multinomial logistic regression models, mothers who had experienced high ACEs, high EOD, or high combined ACE-EOD reported more household hardships and were less likely to report that they and their young children were in good health. Mediation analyses showed evidence that associations with maternal health were partially mediated by household hardships. Our results suggest that maternal ACEs and EOD may undermine maternal and child health via household hardships, along with other potential mechanisms. Counteracting downstream effects of these adversities requires timely intervention on multiple levels, including addressing remediable household hardships. Ultimately, a focus on achieving equity comprehensively through policy design and implementation is needed to realize the full potential of public policies for supporting family and child health.

Biopsychosocial pathways model of early childhood appetite self-regulation: Temperament as a key to modulation of interactions among systems

The widespread discrimination against individuals with obesity often stems from a simplistic perception of obesity as a mere consequence of personal choices of overeating and insufficient physical activity. This reductionist perception fails to acknowledge the complexity of the epidemic of obesity, which extends beyond diet and exercise decisions. The concept of appetite self-regulation (ASR) has been explored as a crucial element in identifying obesogenic behavioral approaches to food. Although an extensive understanding of ASR in children is essential as an early precursor and modifiable factor influencing obesity, the prevailing view of self-regulation of eating solely as a matter of cognitive and behavioral processing tends to overlook interacting systems of influences. This narrow approach attributes obesity to the lack of voluntary self-control in food consumption while neglecting to account for the biological, psychological, and social influences implicated in the developmental processes of ASR, which may further contribute to the stigmatization of obesity. The current critical analysis provides a comprehensive developmental framework that could guide future studies with testable hypotheses, outlining pathways of interactions among biopsychosocial systems, all of which contribute to the development of ASR in early childhood. Adopting developmental perspectives allows a holistic approach to investigating ASR, which accounts for intricate interactions between biological (B), psychological (P), and social (S) factors influential in the early manifestation of ASR.

The community food environment as an effect modifier of the relationship between racial discrimination and food insecurity among adults in Southern Brazil

BACKGROUND

Racial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity.

METHODS

This was a cross-sectional study of 400 adults aged 20-70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis.

RESULTS

The prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03-1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01-1.10).

CONCLUSIONS

Experiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity.

Perceived Discrimination Among Food Pantry Clients in Massachusetts

Introduction

Food insecurity is defined as inconsistent access to enough food to meet nutritional needs. Discrimination is associated with food insecurity and poor health, especially among racial and ethnic minoritized and sexual or gender minoritized groups. We examined the demographic associations of perceived everyday discrimination and food pantry discrimination in Massachusetts.

Methods

From December 2021 through February 2022, The Greater Boston Food Bank conducted a cross-sectional, statewide survey of Massachusetts adults. Of the 3,085 respondents, 702 were food pantry clients for whom complete data on food security were available; we analyzed data from this subset of respondents. We used the validated 10-item Everyday Discrimination Scale to measure perceived everyday discrimination and a 10-item modified version of the Everyday Discrimination Scale to measure perceived discrimination at food pantries. Logistic regression adjusted for race and ethnicity, age, gender identity, sexual orientation, having children in the household, annual household income, and household size assessed demographic associations of perceived everyday discrimination and discrimination at food pantries.

Results

Food pantry clients identifying as LGBTQ+ were more likely than those identifying as non-LGBTQ+ to report perceived everyday discrimination (adjusted odds ratio [AOR] = 2.44; 95% CI, 1.24-4.79). Clients identifying as Hispanic (AOR = 1.83, 95% CI, 1.13-2.96) were more likely than clients identifying as non-Hispanic White to report perceived discrimination at food pantries.

Conclusion

To equitably reach and serve households with food insecurity, food banks and pantries need to understand experiences of discrimination and unconscious bias to develop programs, policies, and practices to address discrimination and create more inclusive interventions for food assistance.

Exploring Correlates of Resource Insecurity Among Older Black or African Americans with HIV in Ohio

OBJECTIVES

Resource insecurity is a social determinant of health that can impact people with HIV (PWH), in particular older African Americans (AA) or blacks with HIV. The purpose of this study was to identify resource insecurities among older Blacks or AA PWH specifically related to food and housing. Secondary focus was to find associations between resource insecurity and substance use history, stigma, and various forms of discrimination.

METHODS

Eligible participants (N = 52) of this cross-sectional study were 50 years old or older, identified as Black or AA, diagnosed with HIV, and living in Ohio. Food insecurity was assessed using the Household Food Insecurity Access Scale and housing insecurity was defined as not having stable housing. Resource insecurity was categorized into food and housing secure, food or housing insecure, and food and housing insecure.

RESULTS

Almost half (48.1%) of participants reported housing insecurity, with approximately 58.0% experiencing food insecurity, and 38.5% facing both. Current substance use, particularly opiates, showed significant association with resource insecurity (OR = 5.54; 95% CI = 1.91-17.30). Moreover, experiences of everyday (OR = 1.19; 95% CI = 1.10-1.30) or major forms (OR = 1.75; 95% CI = 1.33-2.39) of discrimination, as well as HIV stigma (OR = 1.24; 95% CI = 1.01-1.55), were also linked to increased odds of resource insecurity among participants.

CONCLUSIONS

Findings highlight how social factors contribute to resource insecurity among older AA PWH. Understanding the factors offers insight for targeted intervention in the fight against HIV transmission.

A person-reported cumulative social risk measure does not show bias by income and education

BACKGROUND

Social risk such as housing instability, trouble affording medical care and food insecurity are a downstream effect of social determinants of health (SDOHs) and are frequently associated with worse health. SDOHs include experiences of racism, sexism and other discrimination as well as differences in income and education. The collective effects of each social risk a person reports are called cumulative social risk. Cumulative social risk has traditionally been measured through counts or sum scores that treat each social risk as equivalent. We have proposed to use item response theory (IRT) as an alternative measure of person-reported cumulative social risk as IRT accounts for the severity in each risk and allows for more efficient screening with computerized adaptive testing.

METHODS

We conducted a differential item functioning (DIF) analysis comparing IRT-based person-reported cumulative social risk scores by income and education in a population-based sample (n = 2122). Six social risk items were analyzed using the two-parameter logistic model and graded response model.

RESULTS

Analyses showed no DIF on an IRT-based cumulative social risk score by education level for the six items examined. Statistically significant DIF was found on three items by income level but the ultimate effect on the scores was negligible.

CONCLUSIONS

Results suggest an IRT-based cumulative social risk score is not biased by education and income level and can be used for comparisons between groups. An IRT-based cumulative social risk score will be useful for combining datasets to examine policy factors affecting social risk and for more efficient screening of patients for social risk using computerized adaptive testing.

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.

A review of dairy food intake for improving health among black infants, toddlers, and young children in the US

Adequate nutrition is paramount for proper growth and musculoskeletal, neurocognitive, and immunological development in infants, toddlers, and young children. Among breastfeeding mother-child dyads, this critical window of development, is impacted by both maternal and offspring dietary patterns. For mothers, their dietary patterns impact not only their own health and well-being, but also the nutrition of their breast milk - which is recommended as the sole source of food for the first 6 months of their infant's life, and as a complementary source of nutrition until at least 2 years of age. For infants and toddlers, the breast milk, formulas, and first foods they consume can have both short-term and long-term effects on their health and well-being - with important impacts on their taste perception, microbiome composition, and immune function. According to dietary intake data in the US, infants and young children meet a greater number of nutrient requirements than older children and adults, yet numerous disparities among socially disadvantaged racial/ethnic groups still provide significant challenges to achieving adequate nutrition during these early life stages. For example, Black children are at greater risk for disparities in breastfeeding, age-inappropriate complementary feeding patterns, nutrient inadequacies, food insecurity, and obesity relative to most other racial/ethnic groups in the US. For infants who do not receive adequate breast milk, which includes a disproportionate number of Black infants, dairy-based infant formulas are considered the next best option for meeting nutritional needs. Fermented dairy foods (e.g., yogurt, cheese) can serve as ideal first foods for complementary feeding, and cow's milk is recommended for introduction during the transitional feeding period to help meet the nutrient demands during this phase of rapid growth and development. Low dairy intake may put children at risk for multiple nutrient inadequacies and health disparities - some of which may have lifelong consequences on physical and mental health. A burgeoning body of research shows that in addition to breast milk, cow's milk and other dairy foods may play critical roles in supporting physical growth, neurodevelopment, immune function, and a healthy gut microbiome in early life. However, most of this research so far has been conducted in White populations and can only be extrapolated to Black infants, toddlers, and young children. Therefore, to better understand and support the health and development of this population, greater research and education efforts on the role of milk and dairy products are urgently needed. This review presents the current evidence on health disparities faced by Black children in the US from birth to four years of age, and the role that dairy foods can play in supporting the normal growth and development of this vulnerable population.

Racial discrimination is associated with food insecurity, stress, and worse physical health among college students

BACKGROUND

Students of color disproportionately experience racial discrimination and food insecurity, which both lead to poor academic and health outcomes. This study explores the extent to which the location of racial discrimination experienced is associated with food insecurity, stress, physical health and grade point average among college students METHODS: A cross sectional study design was implemented to survey 143 students from a racially diverse public university. Logistic regression models assessed if discrimination at various locations was associated with food insecurity and linear models assessed how racial discrimination was associated with physical health, stress and grade point average RESULTS: Student's experiencing food security had an average discrimination score of 2.3 (1.23, 3.37), while those experiencing food insecurity had a statistically significant (P < 0.001) higher average discrimination score 7.3 (5.4, 9.21). Experiencing any racial discrimination was associated with increased odds of experiencing food insecurity when experienced from the police (OR 11.76, 95% CI: 1.41, 97.86), in the housing process (OR 7.9, 95% CI: 1.93, 32.34) and in the hiring process (OR 6.81, 95% CI: 1.98, 23.48) compared to those experiencing no racial discrimination after adjusting for race, gender, age and income.

CONCLUSION

The location in which a student experienced racial discrimination impacted the extent to which the racial discrimination was associated with food security status. Further research is needed to explore potential mechanisms for how racial discrimination may lead to food insecurity.

Moving Because of Unaffordable Housing and Disrupted Social Safety Net Access Among Children

OBJECTIVES

To measure associations between residential moves because of unaffordable housing costs and disruptions in access to the Supplemental Nutrition Assistance Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; and Medicaid in a health care-based sample of families with young children.

METHODS

We used cross-sectional survey data on social safety net-eligible caregivers and children recruited into the Children's HealthWatch study from emergency departments and primary care clinics in Baltimore and Philadelphia (2011-2019). Children's HealthWatch measured residential moves (cost-driven and noncost-driven) in the past year and disruptions in safety net access. We used logistic regression to estimate associations between each type of move and disrupted access to social safety nets.

RESULTS

Across 9344 children, cost-driven residential moves were associated with higher odds of disrupted access to at least 1 safety net program (Supplemental Nutrition Assistance Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; or Medicaid; adjusted odds ratio 1.44; 95% confidence interval 1.16-1.80), as well as higher odds of disruption to each program separately. Noncost-driven moves were also associated with disruptions to at least 1 safety net program, but less strongly so (adjusted odds ratio 1.14; confidence interval 1.01-1.29; P value for comparison with cost-driven = .045).

CONCLUSIONS

Residential moves, particularly cost-driven moves, are associated with social safety net benefit disruptions. The association between these events suggests a need for action to ensure consistent safety net access among children facing cost-driven moves and vice versa (ie, access to housing supports for children with disrupted safety net access).

Factors Associated With Food Insecurity Among a Community-Based Sample of Older Adults in a North Florida County

Food insecurity impacts the lives of 7.6 million U.S. adults aged 60 and older and is linked to numerous life challenges. This study examined the nature of food insecurity among community-based participants ≥65 years in a north Florida county and conceptualized food insecurity as encompassing the lack of food and individual adaptability. Thus, food insecurity was measured using three dependent variables: (1) worrying that food would run out, (2) cutting meal size or skipping meals, and (3) food not lasting. Logistic regression revealed that older participants, those with better-perceived health status, and those who were confident that they could find solutions to their problems had lower odds of reporting food insecurity. However, respondents who lived in low-income, low-access zip codes and those who received food assistance were more likely to report food insecurity. To improve outcomes and reduce healthcare disparities, solutions to food insecurity must vary in focus and approach.

Effect of a Social Care Intervention on Health Care Experiences of Caregivers of Hospitalized Children: A Randomized Clinical Trial

Importance

Health-related social risks (HRSRs), like food and housing insecurity, are stigmatized conditions that, when addressed in clinical settings, could inadvertently compromise health care experiences.

Objective

To test the noninferiority hypothesis that a low-intensity, high-scale social care intervention does not promote experiences of discrimination or diminish satisfaction with care compared to usual care.

Design, Setting, and Participants

This was a double-blind randomized clinical trial conducted from November 2020 to June 2022 with 12-month follow-up analyzing data obtained 1 week after baseline intervention at a 155-bed academic urban children's hospital with 5300 annual admissions. Participants were recruited from their children's hospital rooms during their children's inpatient hospital stays. Inclusion criteria were identifying as the primary caregiver of a child younger than 18 years who was hospitalized in the general, intensive care, or transplant units; living in 1 of 42 target zip codes; and consenting to receive text messages. Caregivers of healthy newborns and caregivers of children expected to be hospitalized for less than 24 hours or greater than 30 days were excluded. A total of 637 eligible parents and caregivers were enrolled.

Interventions

Participants were randomized to usual care or usual care plus CommunityRx, a low-intensity, universally delivered, electronic medical record-integrated social care assistance intervention providing personalized information about local resources alongside education about HRSRs and how to access additional support. Usual care included an admission brochure about hospital-based free food options and nonsystematic provision of resource information.

Main Outcomes and Measures

Experiences of discrimination, measured using the Discrimination in Medical Settings Scale (range 7-35; higher scores indicate more frequent discrimination) and satisfaction with hospital discharge 1 week postdischarge using Child HCAHPS (range 0-100; higher scores indicate higher satisfaction). The a priori noninferiority margins (control minus intervention) were -0.9 (discrimination) and 1.6 (satisfaction).

Results

Of 637 eligible caregiver participants, most identified as female (n = 600 [94.3%]), Black (n = 505 [79.4%]), and had household income less than $50 000 per year (n = 488 [78.5%]). One-third were experiencing food insecurity (n = 223). Half of participants reported discrimination experiences during the pediatric hospitalization (n = 259). Discrimination experiences among the intervention group were noninferior to those among the control group (mean [SD] score: control, 10.3 [4.7] vs intervention, 10.0 [4.6]; difference, 0.2; 90% CI, -0.5 to 0.9). Mean (SD) satisfaction with discharge was high (control, 84.2 [23.8] vs intervention, 81.9 [24.8]), but evidence was insufficient to support intervention noninferiority for this end point (difference, 2.3; 90% CI, -1.2 to 5.8). Food security status did not moderate the relationship between intervention and either outcome.

Conclusions and Relevance

The findings suggest that a universally delivered social care assistance intervention did not promote caregiver experiences of discrimination during a child's hospitalization but were inconclusive regarding satisfaction.

Trial Registration

ClinicalTrials.gov Identifier: NCT04171999.

Neighborhood Unsafety, Discrimination, and Food Insecurity among Nigerians Aged 15-49

We investigated the association between discrimination, neighborhood unsafety, and household food insecurity (FI) among Nigerian adults, as well as the gender-specific differences in these associations. Our analysis utilized data from the 2021 Multiple Indicator Cluster Survey (MICS), comprising 56,146 Nigerian adults aged 15-49 (17,346 males and 38,800 females). For bivariate analysis, we employed the Rao-Scott chi-square test to examine the relationship between predictors (discrimination, neighborhood unsafety, and a composite variable of both) and the outcome variable (FI). Food insecurity was assessed using both a dichotomous measure (food insecure vs. food secure) and a multinomial variable (food secure, mild FI, moderate FI, and severe FI). To model the association between predictors and FI while controlling for potential confounding factors, we utilized weighted binary and multinomial logistic regression. Among Nigerian adults, the prevalence of having ever experienced FI was 86.1%, with the prevalence of mild FI, moderate FI, and severe FI being 11.5%, 30.1%, and 44.5%, respectively. In the binary model, experiencing discrimination (OR = 1.36, 95% CI = 1.19-1.55), living in an unsafe neighborhood (OR = 1.33, 95% CI = 1.14-1.54), and facing both discrimination and unsafe neighborhood conditions (OR = 1.97, 95% CI = 1.57-2.48) were significantly associated with FI. In the multinomial model, discrimination, neighborhood unsafety, and experiencing both remained associated with moderate and severe FI. In the gender-specific models, discrimination and neighborhood unsafety were found to be significantly associated with FI in women but not in men. This study underscores the importance of implementing policies and programs that address the underlying causes of food insecurity, with specific attention to discrimination and neighborhood safety concerns, particularly for Nigerian women.

Experiences of Racial Discrimination and Periconceptional Diet Quality

BACKGROUND

Racism is a key determinant of perinatal health disparities. Poor diet may contribute to this effect, but research on racism and dietary patterns is limited.

OBJECTIVE

We aimed to describe the relation between experiences of racial discrimination and adherence to the 2015‒2020 Dietary Guidelines for Americans.

METHODS

We used data from a prospective pregnancy cohort study conducted at 8 United States medical centers (2010‒2013). At 6‒13 weeks of gestation, 10,038 nulliparous people with singleton pregnancies were enrolled. Participants completed a Block food frequency questionnaire, assessing usual diet in the 3 mo around conception, and the Krieger Experiences of Discrimination Scale, assessing the number of situational domains (e.g., at school and on the street) in which participants ever experienced racial discrimination. Alignment of dietary intake with the 2015-2020 Dietary Guidelines for Americans was assessed using the Healthy Eating Index (HEI)-2015.

RESULTS

The study showed that 49%, 44%, 35%, and 17% of the Asian, Black, Hispanic, and White participants reported experiences of racial discrimination in any domain. Most participants experienced discrimination in 1 or 2 situational domains. There were no meaningful differences in HEI-2015 total or component scores in any racial or ethnic group according to count of self-reported domains in which individuals experienced discrimination. For example, mean total scores were 57‒59 among Black, 61‒66 among White, 61‒63 among Hispanic, and 66‒69 among Asian participants across the count of racial discrimination domains.

CONCLUSIONS

This null association stresses the importance of going beyond interpersonal racial discrimination to consider the institutions, systems, and practices affecting racialized people to eliminate persistent inequalities in diet and perinatal health.

The citizenship shield: Mediated and moderated links between immigration status, discrimination, food insecurity, and negative health outcomes for latinx immigrants during the COVID-19 pandemic

A framework termed "the citizenship shield" is introduced to conceptualize how legal protections buffer against negative health outcomes among Latinx immigrants in the United States. In this study, we tested the citizenship shield framework in the context of the disproportionate impact of the COVID-19 pandemic on Latinx immigrants. We investigated the connection between immigration status, discrimination, food insecurity, and negative health outcomes. Analyses involved testing mediation and moderation models among a community-based sample of 536 Latinx immigrants holding five statuses (i.e., U.S. citizenship, permanent residency, Deferred Action for Childhood Arrivals, undocumented, and temporary status). Results suggested that food insecurity mediated the link between discrimination and negative impacts from the pandemic for Latinx immigrants across all statuses. Follow up analyses suggested that two of the three paths were moderated by immigration status. This research provides novel, important data to inform health interventions and federal policy targeted for the most vulnerable immigrants in the United States.

Sexual Orientation and Food Hardship: National Survey of Family Growth, 2011-2019

OBJECTIVE

Given the high rates of poverty observed among sexual minority groups and their social vulnerability, we examined the prevalence and correlation of food hardship, measured as food insecurity, receipt of free or reduced-cost food, and Supplemental Nutrition Assistance Program (SNAP) participation among low-income sexual minority and heterosexual adults using population-level health surveillance data.

METHODS

We used 4 waves of pooled data (2011-2019) from the National Survey of Family Growth for adults aged 18-44 years. We compared the sexual orientation subgroups and used logistic regression to predict the likelihood of food hardship.

RESULTS

Among men, gay and bisexual men had higher odds of experiencing food insecurity than their heterosexual counterparts (adjusted odds ratio [aOR] = 1.97 and 1.83, respectively). Compared with heterosexual men, bisexual men had significantly higher odds of receiving free or reduced-cost food, but gay men did not. The odds of participating in SNAP did not differ significantly among gay, bisexual, and heterosexual men. Among women, only bisexual women were more prone to experiencing food insecurity than their heterosexual counterparts (aOR = 1.81). The odds of receiving free or reduced-cost food did not differ significantly among heterosexual, bisexual, and lesbian women. However, compared with heterosexual women, lesbian women had significantly lower odds (aOR = 0.62) and bisexual women had significantly higher odds (aOR = 1.24) of participating in SNAP.

CONCLUSION

Our findings contribute to the limited literature examining trends in food hardship among sexual minority groups and suggest potentially different patterns of food insecurity, food assistance, and SNAP participation among sexual orientation subgroups, which may call for group-specific, nuanced approaches for lessening food hardship.

Food Insecurity Among Older Adults with a History of Incarceration

We examined the association between history of incarceration (HOI) and food insecurity (FI) among older adults using pooled data from 12,702 respondents aged 51+ who participated in the 2012 and 2014 waves of the Health and Retirement Study. In our sample, 12.8% of participants reported FI. Those with a HOI had an increased odds of FI (OR 1.83; 95% CI 1.52-2.21). Race/ethnicity moderated the association between HOI and FI. The positive and statistically significant association was concentrated among Non-Hispanic Black and Non-Hispanic White participants. No statistically significant association was found among Hispanic participants or among those from other racial/ethnic groups. Income, depressive symptoms, and functional limitations mediated the association between HOI and FI, with the largest indirect effects observed for income. FI is an important issue among older adults with a HOI. Programs and policy initiatives to increase food access and/or improve earnings in this population may be needed.

Racial/Ethnic Differences in the Association Between Food Security and Depressive Symptoms Among Adult Foreign-Born Immigrants in the US: A Cross-Sectional Study

Foreign-born immigrants are at greater risks of both food insecurity and depressive symptoms, while the association between the two has yet to be elucidated. Our sample includes 6,857 adults aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. Multivariable logistic regression was used to examine whether the association between food security and depressive symptoms varies across race/ethnicity among US foreign-born immigrants. The prevalence of depressive symptoms was 9.6% and 15.7% for low food security (LFS) and very low food security (VLFS). The adjust odds ratios (aORs) of depressive symptoms among Mexican American and Other Hispanic immigrants with VLFS were 2.66 (95% Confidence interval [CI]: 1.61, 4.38) and 2.05 (95% CI: 1.08, 3.86) as compared to those with full food security (FFS). Race/ethnicity may modify the association between food security and depressive symptoms among US foreign-born immigrants and a dose-response relationship was indicated among Hispanic and Other Race immigrants.

The association between food insecurity and cognitive impairment among the US adults: The mediation role of anxiety or depression

BACKGROUND

Using a nationally representative sample, this study aimed to examine (1) socio-demographic and health-related disparities in cognitive impairment, (2) the association between food insecurity and cognitive impairment, and (3) the mediation role of anxiety or depression in the pathway between food insecurity and cognitive impairment.

METHODS

Cross-sectional data of 28,508 adults from the 2020 National Health Interview Survey were analyzed. Multivariable logistic regression models were used to estimate associations with cognitive impairment. Mediation analyses were conducted using the four-way decomposition method under a counterfactual framework.

RESULTS

Disparities in cognitive impairment were observed across socio-demographic and health-related characteristics (all p < 0.0001). Food insecurity was significantly associated with cognitive impairment in the overall population and the magnitude of the association was greater for the young or middle-aged, females and non-Hispanic Blacks than the general population (AOR ranged from 1.19 to 2.54, all p < 0.01). With anxiety as a mediator, 28.66 % of the total effect of food insecurity on cognitive impairment was attributable to mediation only, and 22.39 % was attributable to interaction (between food insecurity and anxiety) and mediation. With depression as a mediator, 22.33 % of the total effect was attributable to mediation only, and 16.00 % was attributable to interaction (between food insecurity and depression) and mediation.

LIMITATIONS

The cross-sectional design prevents inference of causality.

CONCLUSIONS

Ensuring available and adequate food resources is important to prevent adverse cognitive outcomes. Clinical interventions or treatments for anxiety or depression may help improve cognitive function.

Food insecurity and disasters: predicting disparities in total and first-time food pantry visits during the COVID-19 pandemic

In the U.S. state of Arizona, nearly one-third of households experienced food insecurity during the COVID-19 pandemic, an increase from one-fourth of households before the pandemic. Previous research on food insecurity in the wake of natural and human-instigated disasters demonstrates that groups vulnerable to food insecurity before a disaster are more susceptible to food insecurity during and after that disaster; however, less is known about whether this relationship also holds true during health-related disasters, such as the COVID-19 pandemic. We explore how the COVID-19 pandemic influenced urban food insecurity patterns by analyzing the socio-demographic characteristics of food pantry clients in Maricopa County, Arizona. Using data from Phoenix Rescue Mission (PRM), a local non-profit food service provider, two binomial logistic regression models compare the socio-demographic composition of total and first-time food pantry users before and during the pandemic. In addition to an overall increase in food pantry usage during the pandemic, we find that, while certain socio-demographic groups historically vulnerable to food insecurity experienced the predicted uptick in insecurity during the pandemic, other socio-demographic disparities were attenuated. These somewhat disparate findings illustrate the complex relationship between disasters and food insecurity in an urban context, offering several avenues for future research.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12571-022-01336-2.

State-Level Socioeconomic Racial Inequity and Food Insecurity in the U.S

INTRODUCTION

Racial inequities in food insecurity have been documented for the past 2 decades in the U.S., with the prevalence of food insecurity among Black households being 2-3 times higher than that among White households across time. The purpose of this study was to determine the association between socioeconomic indicators of structural racism at the state level and food insecurity among White and Black households in the U.S.

METHODS

This study is a secondary analysis of pooled, cross-sectional data from the Current Population Survey and the American Community Survey, 2015-2019 (N=158,551 Black and White households). Data analysis occurred in 2021-2022. The outcome was household food insecurity, and the exposure was structural racism indicators, operationalized as state-level racial inequities in income, earnings, education, unemployment, and home ownership. Individual-, household-, and state-level sociodemographic covariates were included.

RESULTS

Among Black households, state-level racial inequities in income, unemployment, and home ownership were associated with 34% (OR=1.34; 95% CI=1.05, 1.70), 14% (OR=1.14; 95% CI=1.02, 1.28), and 11% (OR=1.11; 95% CI=1.05, 1.16) higher odds of food insecurity, respectively. For White households, state-level racial inequities in income, education, unemployment, and home ownership were associated with 21% (OR=0.79; 95% CI=0.63, 0.98), 27% (OR=0.73; 95% CI=0.66, 0.85), 10% (OR=0.90; 95% CI=0.82, 0.98), and 8% (OR=0.92; 95% CI=0.89, 0.95) lower odds of food insecurity, respectively.

CONCLUSIONS

Structural racism may be a key driver of food insecurity among Black households and may be protective against food insecurity among White households. Implementing policies addressing state-level racial inequity in socioeconomic indicators could be effective at reducing racial inequities in food insecurity.

Eviction and Household Health and Hardships in Families With Very Young Children

BACKGROUND

Families with versus without children are at greater eviction risk. Eviction is a perinatal, pediatric, and adult health concern. Most studies evaluate only formal evictions.

METHODS

Using cross-sectional surveys of 26 441 caregiver or young child (<48 months) dyads from 2011 to 2019 in emergency departments (EDs) and primary care clinics, we investigated relationships of 5 year history of formal (court-involved) and informal (not court-involved) evictions with caregiver and child health, history of hospitalizations, hospital admission from the ED on the day of the interview, and housing-related and other material hardships.

RESULTS

3.9% of 26 441 caregivers reported 5 year eviction history (eviction), of which 57.0% were formal evictions. After controlling for covariates, we found associations were minimally different between formal versus informal evictions and were, therefore, combined. Compared to no evictions, evictions were associated with 1.43 (95% CI: 1.17-1.73), 1.55 (95% confidence interval [CI]: 1.32-1.82), and 1.24 (95% CI: 1.01-1.53) times greater odds of child fair or poor health, developmental risk, and hospital admission from the ED, respectively, as well as adverse caregiver and hardship outcomes. Adjusting separately for household income and for housing-related hardships in sensitivity analyses did not significantly alter results, although odds ratios were attenuated. Hospital admission from the ED was no longer significant.

CONCLUSIONS

Demonstrated associations between eviction and health and hardships support broad initiatives, such as housing-specific policies, income-focused benefits, and social determinants of health screening and community connections in health care settings. Such multifaceted efforts may decrease formal and informal eviction incidence and mitigate potential harmful associations for very young children and their families.

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.

“We’ve Always Been Kind of Kicked to the Curb”: A Mixed-Methods Assessment of Discrimination Experiences among College Students

Background: Experiences of discrimination are prevalent among minority populations, although often empirical evidence does not provide depth into the source and types of discrimination, such as racial/ethnic, gender-based, age, etc. The goal of this study was to assess the unique patterns, types, and sources of discrimination experiences that college students face and explore the role these experiences play in their mental health. Methods: An explanatory sequential mixed-methods study was utilized. Quantitative assessment of college students from a Hispanic and minority-serving institution was conducted to evaluate experiences of discrimination and its association to physical health and mental health (including psychological distress), as well as food insecurity, a marker for poverty. Next, qualitative data were thematically analyzed to further provide an in depth understanding on the sources of such experiences, types of discriminations, as well as the impact on mental health. Results: Results of the quantitative assessment highlight that discrimination was prevalent among the population with a higher everyday discrimination score significantly associated with serious psychological distress, low mental health status, low physical health status, and being food insecure. Further, most of the participants reported that they felt discriminated due to their appearance, with race/ethnicity and skin color as next most commonly cited reasons. Qualitative assessment further demonstrates distinct types of discrimination experiences from a variety of sources. Within a family, colorism and having an American accent while speaking a native language was a predominant source, while among peers, having a non-American accent was a primary source of discrimination experiences. Such experiences based on elitism, gender, and age (being younger) from the workplace were prevalent among the target population. Finally, feelings of isolation, not belonging, as well as negative impact on self-efficacy and self-worth were noted. Conclusion: Experiences of discrimination are prevalent among college students, including from within family and peers. To improve mental health outcomes of such a population, campus-based measures are needed to promote resiliency and social support, as well as community-based initiatives to promote workplace training to create inclusive environments for younger generations entering the workforce.

Collecting, Using, and Reporting Race and Ethnicity Information: Implications for Research in Nutrition Education, Practice, and Policy to Promote Health Equity

This report will describe approaches for collecting, analyzing, and reporting race and ethnicity information in nutrition education and behavior research, practice, and policy to advance health equity. Race and ethnicity information is used to describe study participants and compare nutrition and health-related outcomes. Depending on the study design, race and ethnicity categories are often defined by the research question or other standardized approaches. Participant self-reported data are more acceptable than researcher adjudicated identification data, which can add bias and/or error. Valid methods to collect, use, and report race and ethnicity information are foundational to publication quality, findings of value, contribution to the knowledge base, and health equity.

"Food Is Our Love Language": Using Talanoa to Conceptualize Food Security for the Māori and Pasifika Diaspora in South-East Queensland, Australia

Queensland is home to the largest diaspora of Māori and Pasifika peoples in Australia. They form an understudied population concerning experiences and challenges of food insecurity. This community co-designed research aims to explore the conceptualization of household food security by Māori and Pasifika peoples living in south-east Queensland. Participatory action research and talanoa were used to collect and analyse forty interviews with leaders representing 22 Māori and Pasifika cultural identities in south-east Queensland. Eight key themes emerged that conceptualise food security as an integral part of the culture and holistic health. These themes included: spirituality, identity, hospitality and reciprocity, stigma and shame, expectations and obligations, physical and mental health and barriers and solutions. Addressing food insecurity for collectivist cultures such as Māori and Pasifika peoples requires embracing food sovereignty approaches for improved food security through the co-design of practical solutions that impact social determinants and strengthen existing networks to produce and distribute affordable and nutritious food.

Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth

Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.

Clinical and public policy interventions to address food insecurity among children

PURPOSE OF REVIEW

This article describes the impacts of food insecurity (FI) on child health, outlines clinical and public policy interventions to mitigate FI in children, and defines new paradigms in population health to ameliorate the harmful effects of FI in children.

RECENT FINDINGS

Rates of FI among children have dramatically increased with the onset of the COVID-19 pandemic, with particular adverse impact on low-income children. Population health innovations in screening, referral, and social service integration offer new opportunities to address FI.

SUMMARY

Despite advances in clinical practice and public policy, FI remains a persistent issue for many US children. Clinicians and policymakers have opportunities to leverage clinical and community-based integration to improve service delivery opportunities to ameliorate childhood hunger and racial and socioeconomic inequity in the United States.

A cor e o sexo da fome: análise da insegurança alimentar sob o olhar da interseccionalidade

Este trabalho objetiva analisar a (in)segurança alimentar domiciliar sob o olhar da interseccionalidade. Para isso, foram analisados 14.713 domicílios, utilizando-se um questionário estruturado e a Escala Brasileira de Insegurança Alimentar, além dos dados do estudo transversal Qualidade do Ambiente Urbano de Salvador - QUALISalvador, realizado entre 2018 e 2020 em Salvador, Bahia, Brasil. A variável desfecho foi a situação de segurança alimentar (insegurança alimentar leve, moderada ou grave) e a variável exposição de interesse foi o cruzamento de raça/cor e sexo autodeclarado (homem branco, mulher branca, homem negro, mulher negra). Modelos de regressão logística multinominal foram usados para estimar a associação entre a exposição de interesse e o desfecho, ajustada a partir de questões socioeconômicas estratificadas segundo escolaridade e renda familiar per capita. Diante disso, concluiu-se que domicílios chefiados por mulheres negras apresentaram maior chance de insegurança alimentar leve (OR = 1,39; IC95%: 1,15-1,68; p = 0,001) e moderada ou grave (OR = 1,94; IC95%: 1,49-2,52; p < 0,001) em relação aos domicílios chefiados por homens brancos, além de maior chance de insegurança alimentar moderada ou grave em todos os níveis de escolaridade e nas faixas de até 1/2 salário mínimo e > 1 salário mínimo. Quando os responsáveis foram homens negros, a maior chance se apresentou na faixa > 1 salário mínimo. A insegurança alimentar nos domicílios chefiados por mulheres negras, mesmo em condições socioeconomicamente favoráveis, revela-se como uma das consequências da interação estrutural do racismo e do sexismo.

Risk Factors for Veteran Food Insecurity: Findings from a National US Department of Veterans Affairs Food Insecurity Screener

Objective:

Food insecurity is associated with numerous adverse health outcomes. The US Veterans Health Administration (VHA) began universal food insecurity screening in 2017. This study examined prevalence and correlates of food insecurity among Veterans screened.

Design:

Retrospective cross-sectional study using VHA administrative data. Multivariable logistic regression models were estimated to identify sociodemographic and medical characteristics associated with a positive food insecurity screen.

Setting:

All US Veterans Administration (VA) medical centres (n 161). Participants: All Veterans were screened for food insecurity since screening initiation (July 2017–December 2018).

Results:

Of 3 304 702 Veterans screened for food insecurity, 44 298 were positive on their initial screen (1·3 % of men; 2·0 % of women). Food insecurity was associated with identifying as non-Hispanic Black or Hispanic. Veterans who were non-married/partnered, low-income Veterans without VA disability-related compensation and those with housing instability had higher odds of food insecurity, as did Veterans with a BMI < 18·5, diabetes, depression and post-traumatic stress disorder. Prior military sexual trauma (MST) was associated with food insecurity among both men and women. Women screening positive, however, were eight times more likely than men to have experienced MST (48·9 % v. 5·9 %).

Conclusions:

Food insecurity was associated with medical and trauma-related comorbidities as well as unmet social needs including housing instability. Additionally, Veterans of colour and women were at higher risk for food insecurity. Findings can inform development of tailored interventions to address food insecurity such as more frequent screening among high-risk populations, onsite support applying for federal food assistance programs and formal partnerships with community-based resources.

Multiomic biological approaches to the study of child abuse and neglect

Childhood maltreatment, occurring in up to 20-30% of the population, remains far too common, and incorporates a range of active and passive factors, from abuse, to neglect, to the impacts of broader structural and systemic adversity. Despite the effects of childhood maltreatment and adversity on a wide range of adult physical and psychological negative outcomes, not all individuals respond similarly. Understanding the differential biological mechanisms contributing to risk vs. resilience in the face of developmental adversity is critical to improving preventions, treatments, and policy recommendations. This review begins by providing an overview of childhood abuse, neglect, maltreatment, threat, and toxic stress, and the effects of these forms of adversity on the developing body, brain, and behavior. It then examines examples from the current literature of genomic, epigenomic, transcriptomic, and proteomic discoveries and biomarkers that may help to understand risk and resilience in the aftermath of trauma, predictors of traumatic exposure risk, and potential targets for intervention and prevention. While the majority of genetic, epigenetic, and gene expression analyses to date have focused on targeted genes and hypotheses, large-scale consortia are now well-positioned to better understand interactions of environment and biology with much more statistical power. Ongoing and future work aimed at understanding the biology of childhood adversity and its effects will help to provide targets for intervention and prevention, as well as identify paths for how science, health care, and policy can combine efforts to protect and promote the psychological and physiological wellbeing of future generations.

Food insecurity of people with disabilities who were Medicare beneficiaries during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, 54 million people in the United States were food insecure (2020). People with disabilities (PWD) who were Medicare beneficiaries were especially vulnerable to food insecurity prior to the pandemic.

OBJECTIVE

The aim of this study was to explore COVID-19 pandemic food insecurity among PWD who were Medicare beneficiaries.

METHODS

We conducted a secondary analysis of the United States Census Bureau COVID-19 Household Pulse Survey data about the food security of 70,171 PWD who were Medicare beneficiaries (under 65), and a comparison group of 1.1 million non-Medicare beneficiaries (under 65). Data were weighted using frequency person-weights.

RESULTS

Only 44.3% of PWD who were Medicare beneficiaries had enough of the foods they wanted to eat during the pandemic. Reasons for food insecurity included: could not afford to purchase more food (56.9%); stores did not have the food they wanted (31.4%); afraid to go out to get more food (30.0%); could not get out to get more food (21.5%); and could not get food delivered (8.5%). PWD who were Medicare beneficiaries were more likely to be food insecure than non-Medicare beneficiaries. There were also disparities in food insecurity among PWD who were Medicare beneficiaries themselves with household size, Medicaid beneficiaries, gender, race, education, martial status, household income, and Supplemental Nutrition Assistance Program (SNAP) all impacting food security.

CONCLUSIONS

A multipronged approach that addresses not only food-related public health, but also other systems and structures is critical to end food insecurity.

Barriers to Accessing Healthy Food and Food Assistance During the COVID-19 Pandemic and Racial Justice Uprisings: A Mixed-Methods Investigation of Emerging Adults' Experiences

Background

A steep rise in food insecurity is among the most pressing US public health problems that has resulted from the COVID-19 pandemic.

Objective

This study aimed to (1) describe how food-insecure emerging adults are adapting their eating and child-feeding behaviors during COVID-19 and (2) identify barriers and opportunities to improve local food access and access to food assistance.

Design

The COVID-19 Eating and Activity Over Time study collected survey data from emerging adults during April to October 2020 and completed interviews with a diverse subset of food-insecure respondents.

Participants/setting

A total of 720 emerging adults (mean age: 24.7 ± 2.0 years; 62% female; 90% living in Minnesota) completed an online survey, and a predominately female subsample (n = 33) completed an interview by telephone or videoconference.

Main outcome measures

Survey measures included the short-form of the US Household Food Security Survey Module and 2 items to assess food insufficiency. Interviews assessed eating and feeding behaviors along with barriers to healthy food access.

Analyses performed

Descriptive statistics and a hybrid deductive and inductive content analysis.

Results

Nearly one-third of survey respondents had experienced food insecurity in the past year. Interviews with food-insecure participants identified 6 themes with regard to changes in eating and feeding behavior (eg, more processed food, sporadic eating), 5 themes regarding local food access barriers (eg, limited enforcement of COVID-19 safety practices, experiencing discrimination), and 4 themes regarding barriers to accessing food assistance (eg, lack of eligibility, difficulty in locating pantries). Identified recommendations include (1) expanding the distribution of information about food pantries and meal distribution sites, and (2) increasing fresh fruit and vegetable offerings at these sites.

Conclusions

Interventions of specific relevance to COVID-19 (eg, stronger implementation of safety practices) and expanded food assistance services are needed to improve the accessibility of healthy food for emerging adults.

COVID-19-Related Food Insecurity Among Households with Dietary Restrictions: A National Survey

Background

Food insecurity dramatically increased because of the COVID-19 pandemic; however, little is known about pandemic-related food insecurity in households with dietary restrictions.

Objective

To examine pre-pandemic rates of and pandemic-related change in food insecurity among households with and without dietary restrictions.

Methods

A cross-sectional, panel-based survey of 3200 U.S. women was conducted in April 2020. Pre-pandemic food insecurity and early pandemic-related change in food insecurity were assessed using the adapted Hunger Vital Sign. Weighted, multivariate logistic regression was used to model the odds of pre-pandemic food insecurity and the odds of incident or worsening pandemic-related food insecurity among households with and without dietary restrictions. In models predicting pandemic-related outcomes, interaction effects between race/ethnicity and dietary restrictions were examined.

Results

Before the COVID-19 pandemic, households with self-reported food allergy (adjusted odds ratio [aOR]: 1.5, 95% confidence interval [CI]: 1.2-1.9), celiac disease (aOR: 2.3, 95% CI: 1.4-3.5), or both (aOR: 2.1, 95% CI: 1.2-3.6) were significantly more likely to be food insecure than households without restrictions. Households with dietary restrictions were also significantly more likely to experience incident or worsening food insecurity during the early pandemic (food allergy: aOR: 1.6, 95% CI: 1.3-2.1) (celiac disease: aOR: 2.3, 95% CI: 1.5-3.5) (both: aOR: 2.0, 95% CI: 1.2-3.4). Race/ethnicity was not a significant moderator of the relationship between dietary restrictions and pandemic-related food insecurity.

Conclusion

Households with dietary restrictions were more likely to experience both pre-pandemic and pandemic-related incident or worsening food insecurity than households without restrictions. Clinical care for patients with dietary restrictions requires attention to food insecurity.

What Racism Has to Do with It: Understanding and Reducing Sexually Transmitted Diseases in Youth of Color

Sexually transmitted diseases (STDs) are high in populations of color compared to Whites. High-risk sexual behaviors are widely viewed as the key contributors to the levels of STDs, especially in adolescents and young adults. This article situates the sexual risk behaviors of Black, Indigenous, and other young people of color within the framework of racism. It begins with an overview of racial inequities in common STDs and shows how racism gives rise to several risk factors for high-risk sexual behaviors. These risk factors for STDs identified in prior research are best understood as adaptations to the challenges and constraints faced by youth in socially disadvantaged environments. Both social adversity and the mental health problems that it triggers can lead to risky sexual behaviors. Drawing on findings from prior research with youth of color, this paper describes the needed interventions that can markedly reduce STDs and their risk factors. It also describes needed research on interventions that could contribute to the knowledge and understanding of the adverse conditions fueled by racism that affect youth of color, their health, and their communities.

Emerging adults' intersecting experiences of food insecurity, unsafe neighbourhoods and discrimination during the coronavirus disease 2019 (COVID-19) outbreak

OBJECTIVE

To examine how food insecurity is related to emerging adults' food behaviours and experiences of neighbourhood safety and discrimination and to identify resources needed to support their health during the COVID-19 outbreak.

DESIGN

Rapid response online survey. Participants completed the six-item US Household Food Security Survey Module, a brief measure of food insufficiency, and measures of food behaviours, neighbourhood safety and discrimination. Open-ended questions were used to assess changes in eating behaviours during COVID-19 and needed resources.

SETTING

C-EAT (COVID-19 Eating and Activity over Time) study invitations were sent by email and text message to a longitudinal cohort.

PARTICIPANTS

A total of 218 emerging adults (mean age = 24·6 (sd 2·0) years, 70·2 % female) completed a survey in April-May 2020 during a stay-at-home order in Minnesota.

RESULTS

The past year prevalence of food insecurity was 28·4 %. Among food-insecure respondents, 41·0 % reported both eating less and experiencing hunger due to lack of money in the past month. Food-insecure respondents were less likely than those who were food secure to have fruits/vegetables at home and more likely to have frequent fast-food restaurant meals, feel unsafe in their neighbourhood and experience discrimination during the stay-at-home order. Food-insecure adults reported changes including eating more food prepared at home, eating more take-out restaurant meals and purchasing more energy-dense snacks as a result of events related to COVID-19. Resources most needed to support their health included eligibility for more food assistance and relief funds.

CONCLUSIONS

Food-insecure emerging adults experience many barriers to maintaining healthful eating patterns during COVID-19.

Sexual orientation and food insecurity: findings from the New York City Community Health Survey

OBJECTIVE

Food insecurity is a serious public health concern that disproportionately impacts minority groups. However, limited research has assessed food insecurity among sexual minorities. The current study investigates whether individuals identifying as lesbian/gay or bisexual (LGB) sexual orientation were more likely to experience food insecurity relative to heterosexual persons.

DESIGN

Data are from the 2017 and 2018 New York City Community Health Survey. Multinomial logistic regression is used to assess the association between sexual orientation and food insecurity.

SETTING

A sample of adults (18 years and older) who identify as heterosexual, gay/lesbian or bisexual living in New York City in 2017 and 2018.

PARTICIPANTS

18 610 non-institutionalised adults.

RESULTS

Bisexual individuals have significantly higher rates of both mild (relative risk ratio (RRR) = 1·719, 95 % CI 1·148, 2·573) and moderate-to-severe food insecurity (RRR = 1·851, 95 % CI 1·097, 3·122) relative to heterosexual individuals, net of covariates from demographic, household and socio-economic characteristics. Study findings showed no difference in the likelihood of food insecurity between gay/lesbian individuals and heterosexual individuals.

CONCLUSION

Results illustrate a complex interplay between sexual orientation and food insecurity among adults living in New York City. Findings suggest that efforts to connect LGB individuals to public assistance programmes such as Supplemental Nutritional Assistance Program, as well as providing information and connections to food assistance through local LGBTQ+ centres, government agencies (i.e., NYC Human Resources Administration) and non-profit organisations (i.e., Food Bank for New York City) may be beneficial approaches to alleviate food insecurity among this population.

Influence of Psychosocial Variables on the Health of People Living in Housing Exclusion

The aim of this study was to analyze the influence of some personal characteristics, health variables, and social support on the self-rated health of people in housing exclusion in Spain. For that purpose, we used the FOESSA Survey of Social Integration and Needs database, with a final sample of 1574 households. Being more educated and reporting a good life satisfaction stood out as the main factors preventing worse health status. Furthermore, results showed that being female, experiencing poverty-related food insecurity, not having health insurance, experiencing widowhood or partner bereavement, and having caring responsibilities for others or having a disabled person in the household are associated with increased reporting of regular or poor health. On the other hand, being young, having a diagnosed/long-term illness, and a big household size are preventive factors for good health. These results allowed identifying risk and prevention factors to inform interventions to improve the health of those living in housing exclusion. Promoting better education levels, social support, and overall life satisfaction could be important to improve health in this population. Developing social support policies for caring responsibilities and food insecurity must be a priority to improve the health of people living in housing exclusion.

Measuring Food Insecurity Using the Food Abundance Index: Implications for Economic, Health and Social Well-Being

High levels of food insecurity signal the presence of disparities and inequities in local food access, which have been shown to negatively impact the health and well-being of individuals and communities. However, the approaches used to define and measure high food insecurity, also known as a "food desert", vary widely across research study and intervention methodology. This paper describes the development and validation of a measurement tool called the "Food Abundance Index" (FAI) which is a scorecard for assessing levels of food insecurity across five key dimensions: access, diversity, quality, density, and affordability. A pilot study was conducted to examine levels of food insecurity in order to test the extent to which the FAI can detect food deserts. Nine neighborhoods were selected based on the demographic characteristics of communities shown to be related to food insecurity. Our findings provide evidence that the Food Abundance Index provides a robust measurement tool to assess the extent of food insecurity within a community or neighborhood. Thus, this multidimensional scorecard can be used in future research to detect levels of food insecurity within urban areas and help to bridge the gap between academics, policymakers and practitioners in this important area.

Factors Associated with Food Insecurity Following Hurricane Harvey in Texas

Food insecurity prevalence among disaster-affected households has been found to be higher than state prevalence in non-disaster times. This study applies a socio-ecological model of post-disaster food insecurity to a nested quota sample (n = 1002) recruited for a web survey from 41 Texas counties affected by Hurricane Harvey 12-15 months post-event. This analysis identifies risk and protective factors for food insecurity. Chi-square analysis was used to examine independent associations between individual, household, and social factors with food insecurity. A multivariate logistic model was fitted and adjusted odds ratios are reported. Economic instability (adjusted odds ratio (OR) 2.43; 95% Confidence Interval (CI) 1.73, 3.41), relocation due to Hurricane Harvey (OR 1.89; CI 1.15, 3.09), major home damage (OR 2.11; CI 1.12, 3.98), non-white race - black (OR 1.79; CI 1.01, 3.18), Hispanic (OR 1.67; CI 1.09, 2.54), other race (OR 4.39; CI 1.96, 9.82) - and community-based organization assistance (1.99; 1.11, 3.58) were risk factors while older age (45-64 years: 0.49; 0.32, 0.73; 65+ years 0.40; 0.22, 0.75), better physical health (0.46; 0.29, 0.71), better mental health (0.46; 0.32, 0.67), and high social support (0.37; 0.25, 0.55) were protective against food insecurity. Disaster policies and programs should address the disproportionate burden on households that relocate or have health conditions. Fostering social support networks, especially among relocated populations, may improve disaster health outcomes.

Food Insecurity and Eating Disorders: a Review of Emerging Evidence

PURPOSE OF REVIEW

This review summarizes emerging evidence for the relationship between food insecurity and eating disorder (ED) pathology, outlines priorities for future research in this area, and comments on considerations for clinical and public health practice.

RECENT FINDINGS

Among adults, food insecurity is cross-sectionally associated with higher levels of overall ED pathology, binge eating, compensatory behaviors, binge-eating disorder, and bulimia nervosa. Evidence for similar relationships among adolescents has been less robust; however, compared to studies of adults, there have been substantially fewer studies conducted in adolescents to date. Emerging evidence consistently indicates that food insecurity is cross-sectionally associated with bulimic-spectrum ED pathology among adults. Findings emphasize the need for ED research to include marginalized populations who have historically been overlooked in the ED field. Much more research is needed to better understand the relationship between food insecurity and ED pathology and to determine effective ways to intervene.