Explaining Racial Inequality in Food Security in Columbus, Ohio: A Blinder-Oaxaca Decomposition Analysis

Food Insecurity is Associated with Low Dietary Diversity in Rural Women in Mexico: Results from the Mexican National Health and Nutrition Survey, ENSANUT 2018

Rural women suffer greater vulnerability to food insecurity (FI) compared to their urban or male counterparts. We analyzed the association between food security (FS) status and dietary diversity (DD) in rural women through data from the Mexican National Health and Nutrition Survey (ENSANUT) 2018 from 2,099 rural women. DD was measured using a semi-quantitative food frequency questionnaire. FS was measured using the Latin America and Caribbean Food Security Scale (ELCSA). The prevalence of any level of FI was 70.1%. Mean DD score was 3.8. Mild FI was associated with low DD (OR 1.49, 95% CI 1.06, 2.10). Results highlight the need for government strategies targeted to this population sector to improve their diet quality.

Along party Lines: Examining the gubernatorial party difference in COVID-19 mortality rates in U.S. Counties

Drawing upon the literatures on risk factors for COVID-19 and the roles of political party and political partisanship in COVID-19 policies and outcomes, this study quantifies the extent to which differences in Republican- and Democrat-governed counties' observable characteristics explain the Republican - Democrat gap in COVID-19 mortality rate in the United States. We analyze the county COVID-19 mortality rate between February 1 and December 31, 2020 and employ the Blinder-Oaxaca decomposition method. We estimate the extent to which differences in county characteristics - demographic, socioeconomic, employment, health status, healthcare access, area geography, and Republican vote share, explain the difference in COVID-19 mortality rates in counties governed by Republican vs Democrat governors. Among 3,114 counties, Republican-governed counties had significantly higher COVID-19 mortality than did Democrat-governed counties (127 ± 86 vs 97 ± 80 per 100,000 population, p < 0.001). Results are sensitive to which weights are used: of the total gap of 30.3 deaths per 100,000 population, 12.8 to 20.5 deaths, or 42.2-67.7 %, are explained by differences in observable characteristics of Republican- and Democratic-governed counties. Difference in support for President Trump between Republican- and Democrat-governed counties explains 25 % of the additional deaths in Republican counties. Policies aimed at improving population health and lowering racial disparity in COVID-19 outcomes may also be correlated with reducing the partisan gap in COVID-19 mortality.

Food Insecurity and Mental Well-Being in Immigrants: A Global Analysis

INTRODUCTION

This study estimates the prevalence of food insecurity, mental well-being, and their associations among immigrants and compares the food insecurity-mental well-being associations with nonimmigrants globally and by region.

METHODS

The Gallup World Poll data from 2014 to 2019 were analyzed in 2021. A total of 36,313 immigrants and 705,913 nonimmigrants were included. Food insecurity was measured by the Food Insecurity Experience Scale. Mental well-being was assessed using the Negative Experience Index and Positive Experience Index. A community attachment index was used to measure the living environment. Multilevel mixed-effect linear models were used to examine how the Negative Experience Index/Positive Experience Index was associated with food insecurity and the community attachment index in immigrants and nonimmigrants, adjusting for sociodemographic characteristics, survey years, and country fixed effects. The modifying effects of immigration status on food insecurity-mental well-being associations were tested.

RESULTS

The weighted proportion of food insecurity among global immigrants was 38.6% during 2014-2019. In the pooled adjusted model, food insecurity was dose-responsively associated with greater Negative Experience Index and lower Positive Experience Index than the food-secure ref (p<0.001 for trend). Similar dose-response associations were observed in nonimmigrants and in region-specific analyses. Community attachment marginally affected the food insecurity-mental well-being associations (all p≤0.001 for interaction). Immigration status significantly modified the food insecurity-mental well-being associations in all analyses (all p=0.01 for interaction), and immigrants experienced poorer mental well-being than nonimmigrants at the same level of community attachment and food insecurity.

CONCLUSIONS

Food insecurity is prevalent and is associated with poor mental well-being in immigrants worldwide. Future interventions are needed to alleviate food insecurity and promote community attachment to improve mental health among immigrants, especially in Asian and Pacific countries.

Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: A decomposition analysis

BACKGROUND

Safety-net hospitals (SNHs) treat more maternal patients with risk factors for postpartum readmission.

OBJECTIVE

To assess how patient, hospital, and community characteristics explain the SNH/non-SNH disparity in postpartum readmission rates.

DESIGN

A linear probability model assessed covariates associated with postpartum readmissions. Oaxaca-Blinder decomposition estimates quantified the contribution of covariates to the SNH/non-SNH disparity in postpartum readmission rates.

SETTING

Healthcare Cost and Utilization Project 2016-2018 State Inpatient Databases from 25 states.

PARTICIPANTS

3.5 million maternal delivery stays.

MEASUREMENTS

The outcome was inpatient readmission within 42 days of delivery. SNHs had a share of Medicaid/uninsured stays in the top quartile. A range of patient, hospital, and community characteristics was considered as covariates.

RESULTS

The unadjusted postpartum readmission rate was 4.2 per 1000 index deliveries higher at SNHs than at non-SNHs (19.1 vs. 14.9, p < .001). Adjustment reduced the risk difference to 0.65 per 1000 (95% confidence interval [CI]: -0.14, 1.44). Patient (66%), hospital (14%), and community (4%) characteristics explained 84% of the disparity. The single largest contributors to the disparity were race/ethnicity (20%), hypertension (12%), hospital preterm delivery rate (10%), and preterm delivery (7%). Collectively, patient comorbidities explained 31% of the disparity.

CONCLUSION

Higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. Hospital initiatives are needed to reduce the risk of postpartum readmissions among SNH patients. Improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, requires enduring investments in public health.

The Measurement of Food Insecurity in High-Income Countries: A Scoping Review

The measurement of food insecurity is essential to monitor the prevalence, risk factors, consequences and effects of food insecurity and the interventions and policies implemented to tackle it. Yet, how best to apply it remains an unsettled issue due to the multifaceted and context-dependent nature of food insecurity. We report a scoping review of measures of food insecurity at the individual and household level in high-income countries with the final purpose of facilitating a catalogue of instruments to be used by both researchers and practitioners. The scoping review was conducted following the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute guidelines. We included all types of documents published between 2000-2020 using instruments that estimate food insecurity at both individual and household level in high-income countries, and with respondents including adolescents, adults, and elderly. We identified a total of 23 measurement strategies being used in 33 peer-reviewed publications and 114 documents from the grey literature. Our results show that most measures focus on the access dimension of food insecurity and that further research is required to develop measures that incorporate aspects of quality of dietary intake and relevant individual, household and social conditions related to food insecurity.

Racialized Experiences Differentiate Food Security Among African American Adults

BACKGROUND

Patterns of food security persistently vary by race, yet limited research has examined how community-specific experiences of race and racism are associated with nutritional outcomes.

OBJECTIVES

This analysis describes a novel approach for classifying experiences of race and racism and explores the relationship between identified classes and measures of food security and diet quality.

METHODS

Cross-sectional self-reported survey data from 306 African American adults living in two urban midwestern cities were collected in 2017-2018. Measures of racialized experiences assessed consciousness of race, perceived discrimination, and health effects of perceived discrimination. Food security was measured with a six-item screener and diet quality with the Healthy Eating Index-2010. Latent class analysis was used to generate racialized classes. Bivariate analyses were conducted to examine differences in class membership by sociodemographics and nutrition outcomes.

RESULTS

Participants were majority women who were receiving Supplemental Nutrition Assistance Program benefits. Three racialized classes were identified: Class 1 reported few racialized experiences (42.8% of the sample), Class 2 was racially conscious with few experiences of discrimination (45.1%), and Class 3 was both racially conscious and affected by racialized actions (12.1%). Racialized classes were significantly different in mean household income, level of education, home ownership, and job loss in the past year. Class 3 was the least represented among those that were food secure and the most represented among those that were very low food secure. There were no differences by class in Healthy Eating Index-2010 scores.

DISCUSSION

Findings offer an innovative method for measuring exposures to racism and for assessing its relationship to food security. Findings highlight heterogeneity of racialized experiences in similar contexts as well as potential root cause targets such as wages, education, home ownership, and employment that may be modulated to mitigate the effects of racism on food insecurity.