Do food skills protect from food insecurity? A study among asylum seekers living in Norway

Background

Food insecurity has a high prevalence among asylum seekers living in Western countries. Previous studies suggest that food skills can protect against food insecurity. This study investigates the impact of food skills on food security and dietary diversity among refugees living in Norwegian reception centers.

Methods

The study has a cross-sectional research design. Eight asylum reception centers where selected and 205 asylum seekers (131 men and 74 women) were recruited through convenience sampling among the largest asylum seeking groups. We measured food skills by adopting questions from the Canadian Community Health Survey 2013 Rapid Response on Food Skills. Food skills were divided into cooking skills (ability to prepare meals) and shopping skills (ability to plan meals and budgeting). Food security was measured with the 10-item version of the Radimer/Cornell Hunger and Food Insecurity Scale. Dietary data was collected via a 24-hour recall, and the Food and Agriculture Organization of the United Nations (FAO) dietary diversity score was calculated to assess dietary quality. Data were analyzed with bivariate logistic analysis.

Results

Cooking skills and shopping skills contribute differently to food security and dietary diversity. Higher cooking skills were associated with higher dietary diversity but not with food security. Shopping skills were not associated with either food security or dietary diversity. Women had better cooking skills then men, but there were no gender differences in shopping skills. Married asylum seekers had better shopping skills than those who were not married.

Conclusions

Cooking skills have an impact on dietary diversity, initiatives promoting cooking skills should be encouraged. Further research is needed on what kind of purchasing skills can be useful for asylum seekers coping. Despite high food skills the level of food insecurity remained high. Initiatives addressing the multiple causes of food insecurity are needed.

Key messages

Food skills alone do not protect from food insecurity. Cooking skills are easier to transfer in a new food environment than shopping skills.

Health literacy among first-generation Italian immigrants in Norway

Background

People with an immigration background often have poorer health than the general population. Italians in Norway have tripled throughout the past 15-years, but little is known about their health. Health literacy (HL) has been emerging as a fundamental construct in enabling citizens to play an active role in improving their own and theirs community's health. The objective of our study was i) to describe HL among first-generation Italian immigrants in Norway, ii) examine the association between HL and health-related empowerment, and iii) compare HL in Italian immigrants with the general Norwegian population's.

Methods

The data was retrieved from a cross-sectional survey (n = 321) conducted within the study Mens Sana in Corpore Sano (inclusion criteria: age ≥18 years, living in Norway permanently, having lived in Italy at least until age 16). HL was measured using the short form of the European Health literacy survey questionnaire (HLS-Q12; α = 0.83). Empowerment was assessed using a 4-items scale (α = 0.73), developed on basis the World Health Organization's definition of individual empowerment and aspects of patient empowerment. Additionally, information about gender, age, educational level, and self-rated health was collected.

Results

Preliminary results indicated that 8% had inadequate HL, whereas about 40% had marginal HL. No significant differences in HL were observed in relation to gender, age, education level or general health. A medium correlation was found between HL and empowerment (r = 0.42, p < 0.001). The Italian's HL was significantly lower than the general Norwegian population's (M±SD = 32.46±4.79 and 33.11 ± 4.12, respectively; p = 0.028).

Conclusions

This is the first study investigating HL and its associations with the health-related empowerment of first-generation Italian immigrants in Norway. More research is needed in order to better understand this phenomenon as well as the effectiveness of HL-enhancing initiatives.

Key messages

We investigated the levels of health literacy and health-related empowerment among first-generation Italian immigrants in Norway. The Italians’ heath literacy, which correlated with empowerment, was lower than the general Norwegian population’s. There were no differences across gender, age, education level or general health.

Developing a literature-based systems map of determinants of dietary intake in low-income groups

Background

Inequalities in obesity and related non-communicable diseases pertain in part to less healthy dietary intake in disadvantaged groups. Examining determinants of intake as a complex adaptive system - i.e. interconnected determinants exerting non-linear influence on outcomes - honours the complexity of dietary choices, behaviours and intake, and could inform policies. This study used literature to map the complex system underlying dietary intake in low-income groups, to identify system structure and goals perpetuating poorer dietary outcomes.

Methods

A systematic umbrella literature review examined determinants of dietary outcomes in children, adolescents and adults. Inclusion criteria were: • Low-income sample; analysis by income (Non-)systematic review of quantitative/qualitative, observational/intervention studiesHigher/upper-middle-income countriesExposures: individual, sociocultural, physical, political determinants/correlates; effect modifiers

Excluded outcomes were: breastfeeding, alcohol and neophobia.

Using causal loop diagramming, extracted data on determinants, associations and interpretation were embedded in a systems map of mechanisms driving dietary intake. System structure (e.g. sub-systems) and goals (e.g. feedback loops) were analysed.

Results

A systems map of hypothesised mechanisms driving dietary intake in low-income groups was developed from 43 reviews and expert consensus. The system comprised sub-systems: 1) accessibility, 2) household resources, 3) financial constraints, 4) health/biology, 5) knowledge, attitudes and beliefs, 6) sociocultural influences. Identified sub-system goals could undermine healthy intake opportunities, e.g. energy-dense food choices for cost-efficiency, heightened exposure to energy-dense foods determining preferences.

Conclusions

The literature-based systems map articulates the systemic basis of poorer dietary outcomes in low-income groups. Understanding system structure and goals will inform equitable policy.

Key messages

Dietary intake in low-income groups is driven by a complex system of mechanisms which may perpetuate poorer dietary outcomes. Existing literature was synthesised as a systems map; identification of structures and goals of the system can inform health equity policies.

Benchmarking the implementation of recommended food environment policies in Norway using the Healthy Food Environment Policy Index (Food-EPI)

Background

Obesity prevalence in Norway has increased over the past decades despite political objectives and strategies for obesity prevention. Healthy food environments have the potential to improve the diet of the population and decrease the burden of disease. Governments play a critical role to form such environments. The aim of the study was to assess the efforts of the Norwegian Government towards creating healthier food environments and suggest actions using the Healthy Food Environment Policy Index (Food-EPI) methodology.

Methods

Evidence of policy implementation was assembled and verified by government stakeholders for 45 good practice indicators across 12 policy and infrastructure support domains. Independent public health nutrition experts from academia and civil society (n = 34) assessed the level of implementation of each indicator compared with international best practices, using an online tool.

Results

Most indicators were rated at “medium” level of implementation (51%). An almost equal number of indicators were rated at “high” and “low” level of implementation (21% and 28%, respectively). None of the indicators were rated as “very low, if any” level of implementation. More indicators under the infrastructure domain were rated at “high” or “medium” as compared with the policy domain. The expert panel developed a list of priority actions that should be implemented to improve the food environment, including actions regarded as most effective in decreasing social inequalities in diet. The top priority action was that the Government should to a larger extent use price and taxes to change food consumption.

Conclusions

The Food-EPI framework and process can be used to identify gaps in national policy implementation and to develop recommendations for strengthened policy action supported by a coalition of public health experts.

Developing culturally adapted lifestyle interventions for South Asian migrant populations: a qualitative study of the key success factors and main challenges

OBJECTIVES

South Asian migrant populations have a high risk of non-communicable diseases, such as type 2 diabetes (T2D). The aim of this study is to provide in-depth insight into key success factors and challenges in developing culturally adapted lifestyle interventions to prevent T2D within South Asian migrant populations.

STUDY DESIGN

The study has a qualitative research design.

METHODS

In-depth interviews, using a semi-structured interview guide, were conducted with eight researchers and project leaders from five studies of culturally adapted lifestyle interventions for South Asian migrant populations. Data were analysed using a grounded theory approach.

RESULTS

Four main themes emerged as key factors for success: 'approaching the community in the right way', 'the intervention as a space for social relations', 'support from public authorities' and 'being reflexive and flexible'. Two themes emerged as challenges: 'struggling with time' and 'overemphasising cultural differences'.

CONCLUSIONS

Our findings augment existing research by establishing the importance of cooperation at the organisational and institutional levels, of fostering the creation of social networks through interventions and of acknowledging the multiplicity of identities and resources among individuals of the same ethnic origin.

Dermatophytes and dermatophytoses in the Milan area between 1970 and 1989

Between 1970 and 1989 we examined 13,019 patients with dermatophytoses in the Milan area, Northern Italy. The results obtained during the 1980-89 period were compared with those obtained in the years 1970-79. From the data collected, tinea corporis emerged as the most frequently observed dermatophytosis, followed by tinea pedis and unguium. As far as dermatophytes are concerned, the dermatological pattern is dominated by Microsporum canis and Trichophyton rubrum. Other species, such as Epidermophyton floccosum, T. mentagrophytes, M. gypseum, T. violaceum, T. verrucosum, T. tonsurans and T. schoenleinii, have progressively become less evident. Other mycetes, such as T. megninii, T. soudanense, M. langeroni, T. vanbreuseghemii, M. ferrugineum, sporadically isolated in the 1970-79 period, have disappeared in recent years. An analysis of the distribution and frequency of the dermatophytes according to the cutaneous area affected is reported.

Tinea corporis bullosa

The paper reports a case of tinea corporis bullosa in a 63-year-old woman. Near the classical annular lesions on the anterior surface of the left leg, the patient presented frank bullous lesions. Serous fluid from the bulla yielded Microsporum canis, the first report of the association of this fungus with bullous lesions in tinea corporis. The patient was investigated with routine examinations and immunological studies which showed an intense inflammatory process much greater than in usual cases of tinea corporis.

Pityriasis versicolor of the face

Pityriasis versicolor (p.v.) is a superficial mycosis occurring frequently on the face. Epidemiological and clinical data regarding cases of p.v. on the face over a period of 11 years are discussed and some explanation given for conditions which favour facial involvement. This study underlines that face lesions of p.v. are more common in children than in adults and in females than in males. The forehead is the site of facial involvement usually affected. Clinical features are variable but we often observed achromic or hypopigmented scaling lesions, smaller than trunk patches.

Tinea pedis in children

Tinea pedis is a superficial mycosis, unusual in children. Epidemiological and clinical data regarding cases of tinea pedis observed in children over a period of 20 years are discussed and some explanation given for the conditions which predisposed children to the infection. Clinical features are variable and similar to adults. Bullous lesions are more frequently seen in children. Most of the cases were seen in children over 10 years of age. Males are more often affected with tinea pedis: this is particularly true for 10 to 13 year-old children. As in adults, Trichophyton rubrum is the most frequently isolated etiological agent.

Pityriasis versicolor in the pediatric age

Pityriasis versicolor (PV) is a superficial mycosis, theoretically unusual in children. Epidemiologic and clinical data for children with PV over 11 years was collected. Some explanations are given for the conditions that favored this mycotic infection in children. This study confirms that the face is a usual site of PV in children, in contrast to its rarity as a site in adults. Clinical features are variable and similar to adults. Both sexes are equally affected. The family history is often positive for PV.

Tinea capitis in adults

Scalp ringworm is unusual after puberty. Etiological, epidemiological and clinical data regarding cases of tinea capitis in the elderly observed over a period of 15 years are discussed and some explanations are given for the conditions which favoured the mycotic infection of the scalp in adults. This study underlines that tinea capitis in the elderly is usually characterized by very variable and often atypical lesions and that female preponderance in adult cases of scalp ringworm is striking and unexplained. Moreover, all the dermatophytes we isolated from scalp lesions in children can cause tinea capitis in adults.