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

Childhood Food Insecurity Trajectories and Adult Weight and Self-Reported Health

INTRODUCTION

Research has demonstrated that food insecurity during childhood is associated with worse physical and mental health in childhood. However, little is known about how food insecurity during childhood impacts health outcomes in young adulthood.

METHODS

This study analyzed data from the Future of Families and Child Wellbeing Study (2024), a longitudinal birth cohort study of children born in 1998-2000. Childhood food insecurity trajectory groups from age 3 to 15 years were identified using group-based trajectory modeling. Associations between childhood food insecurity trajectory groups and young adult weight (BMI, overweight status, and obese status) and high self-reported health (good/excellent) at age 22 were modeled with multivariate linear and logistic regression.

RESULTS

Three trajectories were identified among 4,296 participants: 66.9% were food secure, 7.5% were food insecure, and 25.6% transitioned from being food insecure-to-secure throughout childhood. In adjusted analyses, young adults assigned to the food insecure-to-secure trajectory group as children had higher BMI (B 0.82, 95% CI [0.07-1.58]) and higher odds of overweight status (OR 1.24, 95% CI [1.01-1.52]) than young adults assigned to the food secure trajectory group as children. Young adults in the food insecure trajectory group as children had lower odds of high self-reported health than those in the food secure trajectory group as children (OR 0.65, 95% CI [0.48-0.89]).

CONCLUSIONS

Food insecurity in childhood is associated with high weight status and poor self-reported health in young adulthood. These findings highlight the importance of childhood food insecurity screening and interventions to promote health throughout the life course.

Understanding How Persons With Maternal Opioid Use Disorder Experience Public Food Assistance Programs WIC and SNAP

BACKGROUND

The current opioid epidemic persists in tandem with the food insecurity crisis, especially among pregnant persons and parents with opioid use disorder (OUD). Limited research exists examining the experience of pregnant persons and parents with OUD and their engagement in federal food assistance programs. This understanding is imperative to address service gaps, destigmatize practices, and ensure food assistance programs are culturally relevant and acceptable. Therefore, the aim of this study were (1) to understand food access and nutrition needs among pregnant persons and parents in OUD treatment and (2) to describe challenges and limitations associated with current food assistance benefits among pregnant persons and parents in OUD treatment.

METHODS

This qualitative study conducted at an OUD treatment program utilized focus group discussions to elicit feedback from participants. A total of 24 participants (≥18 years of age, parent, recipient of food assistance program and OUD treatment) participated.

RESULTS

The average age of participants was 40 years (SD = 7.4), all received outpatient OUD services, and all participants received Medicaid benefits. All but one (95.8%) reported receiving medication for OUD (ie, methadone). A total of 7 major themes were identified from the data including the following: (1) risky behaviors to access food, (2) Breastfeeding Concerns and Women, Infants, and Children (WIC), (3) Challenges with end of Emergency Allotments payments, (4) WIC/Supplemental Nutrition Assistance Program Enrollment and Support, (5) The impact of food insecurity on maternal and family health, (6) Complexity of food shopping with limited resources, and (7) Impact of food insecurity on recovery domains.

CONCLUSIONS

Despite 2 long-standing federal programs aimed at increasing nutrition and food security for families with children, families affected by maternal OUD continue to face significant barriers to nutritional equity. This study provided context to the additive challenges that families affected by OUD experience in the face of food insecurity, and how they have important implications for the family's health.

The association between multimorbidity and food insecurity among US parents, guardians, and caregivers

BACKGROUND

Multimorbidity among parents, guardians, and caregivers may increase the risk of household food insecurity, which would negatively impact both parents and children. However, limited research has been done to evaluate this relationship among this population. To fill this gap, we examined the association between multimorbidity and food insecurity among U.S. parents.

METHODS

Cross-sectional data from 2019 to 2022 of the National Health Interview Survey were analyzed. Parents, guardians, and caregivers with complete data (N = 26,579) were included. Multimorbidity is defined as having 2 or more conditions. In this study, multimorbidity was categorized as 2 or 3 + conditions from a sum of 11 chronic conditions: hypertension, hyperlipidemia, diabetes, arthritis, stroke, cancer, asthma, depression, anxiety, chronic obstructive pulmonary disease, and heart disease. The presence of food insecurity was defined in four nominal categories (secure, marginal food security, low food security, very low food security). Survey-weighted multinomial regression was used to assess the association of multimorbidity with food insecurity categories, controlling for sociodemographic characteristics. The association between physical versus physical-mental comorbidities and food insecurity was also analyzed.

RESULTS

The mean study sample age was 38.8 years, 51% were women and 53% were non-Hispanic White race/ethnicity. Nearly half (49%) had ≥ 1 chronic condition; 23% had 1, 14% had 2, and 13% had 3+. The most common pair of chronic conditions among parents was depression and anxiety, and most common triad was depression, anxiety, and hypertension. After controlling for potential confounders, we found that parents with 3 + conditions had a higher risk of marginal (OR 1.75, 95% CI 1.47-2.10), low (OR 2.20, 95% CI 1.75-2.75), and very low food security (OR 4.1, 95% CI 3.2-5.2) compared to parents with no conditions. Differences were seen in the odds of food insecurity among parents with mental and physical conditions, as opposed to physical comorbidities alone.

CONCLUSIONS

Our findings suggest a higher risk of food insecurity in parents with multimorbidity. Parents with multimorbidity (especially those with comorbid depression and anxiety disorders) may be a key population to identify and intervene on food insecurity to improve health and well-being among US families.

Rewriting the Narrative: Advancing Justice and Equity in the U.S. Food System

The concept of 'food justice' recognizes the systemic injustices embedded in the U.S. food system and the urgent need for transformative policies to ensure equitable access to affordable, nutritious, and culturally relevant food. Limited access to these foods drives food insecurity and increases the prevalence of diet-related diseases in low-income and minority communities. Dominant narratives that individualize hunger and food insecurity often blame the individual and overlook the underlying structural factors that sustain these issues. These narratives have considerable influence. They shape public opinion and can also guide policy decisions. This commentary explores the goals of the food justice movement in the U.S., describes how the food and racial justice movements intersect, and examines the role of commercial marketing and public policy in shaping the food justice discourse. We also reflect on the efforts that should be made to reframe these dominant narratives and facilitate meaningful change in the food environment.

Food insecurity prior to hematopoietic stem cell transplant is associated with malnutrition and worse outcomes

Food insecurity (FI), defined as the lack of continuous access to adequate food, affects 17-55% of cancer patients. Effects may be exacerbated in hematopoietic stem cell transplant (HSCT) patients, who face nutritional challenges due to treatment side effects, leading to weight loss and malnutrition. We hypothesize that pre-HSCT FI increases the risk of malnutrition, requiring nutrition support, and adverse psychosocial outcomes. Between February 2018 and August 2022, 284 patients were screened before HSCT for FI. 71 (25%) were excluded due to missing data. Of the remaining 213, 20 (9.4%) reported pre-HSCT FI. Patients with FI were more likely to develop malnutrition during HSCT (70% vs. 45.1%, p = 0.034) and need total parenteral nutrition compared to those without FI (65% vs. 34.2%, p = 0.013). Patients with FI also were more likely to screen positive for depression (40% vs. 10.4%, p = 0.002) and financial toxicity (75% vs. 25%, p < 0.001). There were no significant differences in survival or other secondary outcomes. Our study demonstrates that pre-HSCT FI significantly increases likelihood of malnutrition, the need for total parenteral nutrition, and adverse psychosocial outcomes in HSCT patients. These findings highlight the critical importance of early identification and interventions to address FI as part of comprehensive cancer care.

Food Insecurity Among Post-Secondary Students in High Income Countries: Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

Food insecurity has recently emerged as a growing problem among students attending post-secondary institutions in high income countries, where it is associated with poorer health outcomes and poorer academic performance. The aim of this systematic literature review and meta-analysis is to synthesize evidence from published studies describing the prevalence of food insecurity among students in post-secondary educational institutions. A broad search was employed to identify any studies related to food security among post-secondary students in high income countries (PROSPERO identifier: CRD42023468944). Four electronic databases were systematically searched: Medline, CINAHL, Global Health, and Embase, in November 2023. Key thematic areas searched were food insecurity and education; no temporal limitations were placed on the search. Only English language peer-reviewed articles were considered. Four authors independently reviewed all articles to identify relevant studies.

RECENT FINDINGS

156 studies are included in this review. Sample sizes ranged from 10 to 122,269 participants (total participants 743,075; 409,047 women) with a median of 4764. Most studies were based in the USA (n = 139, 88%), and most were cross-sectional (n = 131, 84%). All articles were published after 2009, with more than three-quarters (n = 121, 77.5%) published after 2020. One hundred (64%) studies reported the mean age of participants; across these studies the average age was 22.4 years (range 18 to 78 years). Almost all studies employed one form of the USDA household food security survey module. Food insecurity across the whole sample ranged from 11.8 to 98%, the pooled estimate for food insecurity was 42.2%, (95% CI = 38.8-45.8%). Our findings show that a high proportion of students attending post-secondary institutions experience food insecurity, potentially leading to both poorer academic and health outcomes.

Understanding And Comparing Economic Assistance Models To Improve Food Security And Diet Quality: A Rapid Review

Food insecurity and poor nutrition afflict millions of Americans with low incomes. Three policy approaches to address these challenges are widely debated: modifying existing cash-like food assistance programs (that is, increasing benefits with or without imposing nutrition restrictions) or introducing new cash-like food assistance; incentivizing fruit and vegetable purchases; and providing unconditional cash transfers. This rapid review synthesized experimental and quasi-experimental evidence of how these approaches affect food security, diet quality, and dietary intake. Included studies evaluated modifications to cash-like food assistance benefits, nutrition incentives, and cash transfers. Increasing benefits without imposing nutrition restrictions for cash-like food assistance programs has the strongest evidence for improving food security and has mixed evidence for dietary outcomes. Adding nutrition restrictions to such benefits inconsistently improves diet quality and may reduce program participation. Nutrition incentives prompt small increases in fruit and vegetable intake but inconsistent reductions in food insecurity. More research is needed on cash transfers. As the evidence base for the optimal design of economic assistance programs evolves, continued investment in existing food assistance and nutrition incentive programs with strong evidence for effectiveness is essential.

COVID-19 on Food Insecurity in Hispanic/Latino Essential and Non-essential Workers

INTRODUCTION

The COVID-19 pandemic's economic fallout has further exacerbated the health and well-being among Hispanics/Latinos, who maybe overrepresented in essential job industries and are vulnerable to experiencing food insecurity. This study explores whether the COVID-19 pandemic affected food security status differently among Latino/Hispanic essential and non-essential workers in the United States.

METHODS

The COVID-19 Latino health cross-sectional survey was conducted and administered in person and virtually. Bivariate analyses and chi-square tests were performed to investigate the association between essential worker status and changes in food security status during the COVID-19 pandemic. All reported p-values were two-sided; p < 0.05 was considered statistically significant.

RESULTS

Of the 869 Hispanic/Latino respondents, 393 (45%) were deemed essential workers, and 476 (55%) were non-essential workers. About 22% of essential workers reported a household income of less than $20,000, whereas 19% of non-essential workers had an income above $100,000. Half (54%) of essential workers reported food insecurity. Over one-third (35%) of essential and 22% of non-essential workers reported increased food insecurity during the COVID-19 pandemic. Moreover, there was a significant difference in food insecurity status between essential and non-essential Hispanic/Latino workers (p < 0.001).

CONCLUSION

The results underscore the prevalence of food insecurity due to the COVID-19 pandemic and the need to create comprehensive food policies that address the lack of availability of adequate food among Hispanic/Latino essential workers who already face pandemic-related challenges.

A mixed methods study exploring food insecurity and diet quality in households accessing food clubs in England

BACKGROUND

Food clubs are a higher-agency food aid intervention that charge a small fee for a set number of items. Some incorporate longer-term solutions such as budgeting support and cooking skills. These are in place in England to help address inadequate reliable access to affordable, nutritious food. We used a convergent parallel mixed methods design to describe the food insecurity households accessing food clubs experience and to assess diet quality and wellbeing at the start and after at least three months of using food clubs in the South of England.

METHODS

Participants accessing food clubs in Wessex from March 31 to November 3, 2022 were recruited after providing informed consent. They completed a survey at recruitment that collected data on diet and health. Food security was assessed using the modified six-item US Department of Agriculture (USDA) food security survey module, and wellbeing using the short form Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Follow-up surveys were conducted after participants used the clubs for at least three months. Participants were invited to take part in a semi-structured interview.

RESULTS

Of the 90 participants recruited at baseline, 52% were aged 35-54 years, 74% were female, 81% were of White ethnicity, and 71% reported having at least one dependent child. Food security status was calculated in 69 participants who answered all six questions of the USDA module, with 42% reporting low and 43% very low food security. Among participants with follow-up (n = 52), low food security was 41% and very low food security was 18% at follow-up. Eleven participants were interviewed. Two themes explored impact and experiences of food club. Impact illustrated how participants consumed a more varied diet, experienced less financial pressure, and improved health, wellbeing and social interaction. Experiences of food clubs explored limitations of time and food range at clubs, developing a sense of community and overcoming stigma.

CONCLUSION

This study is the first in the UK to explore potential diet, food security and wellbeing impacts of food clubs. Ongoing impact evaluation will enable optimisation of interventions for the populations they serve, such as inviting other organisations/groups to attend/be available for members.

The relationship between household food insecurity and quality of life among children aged 7-13 years: effects of parent-reported disordered eating, anxiety and depression

BACKGROUND

Food insecurity (FI) has been linked to adverse child health outcomes, including developmental, physical, and psychological disorders. However, little is known about the impact of FI on Lebanese children, especially considering the daily social and economic challenges the population faces. These challenges heighten children's vulnerability, particularly with regard to disordered eating, anxiety, and depression, which may act as mediating factors affecting their overall quality of life. This study aims to assess the mediating effects of disordered eating, anxiety, and depression between FI and quality of life among Lebanese children aged 7-13 years.

METHODS

A cross-sectional study was conducted among 504 Lebanese parents of children aged 7-13 years. FI was assessed using the Arab Family Food Security Scale (AFFSS), quality of life using the KIDSCREEN-10, disordered eating with the Eating Disorder Examination-Questionnaire Short-Parent version, anxiety with the Spence Children's Anxiety Scale-Parent, and depression with the Short Mood and Feelings Questionnaire-Parent version. Mediation analysis was performed using PROCESS MACRO v3.4 in SPSS, with 5000 bootstrapped samples.

RESULTS

In total, 30.8% of parents reported severe levels of household FI. The results of the mediation analysis showed that disordered eating, depression and anxiety fully mediated the association between FI and quality of life. Higher FI was significantly associated with higher disordered eating/depression/anxiety, whereas higher disordered eating/depression/anxiety were significantly associated with lower quality of life. FI was not directly associated with quality of life.

CONCLUSION

FI indirectly affects child's quality of life through its impact on disordered eating, anxiety, and depression. Addressing these psychological disorders in children from food-insecure households appears to be essential to improve their overall quality of life. The implications are specific to Lebanon but may provide valuable insights applicable to similar socio-economically and politically challenged areas.

Food and Housing Insecurity, Resource Allocation, and Follow-up in a Pediatric Emergency Department

Introduction

Food and housing insecurity in childhood is troublingly widespread. Emergency departments (ED) are well positioned to identify and support food- and housing-insecure children and their families. However, there is no consensus regarding the most efficient screening tools or most effective interventions for ED use.

Objective

In this cross-sectional study we aimed to investigate the implementation of a food/ housing insecurity screening tool and resource referral uptake in a pediatric ED.

Methods

During the study period (March 1-December 9, 2021), there were 67,297 ED visits at the study institution, which is a freestanding children's hospital. Caregivers of patients presenting to the ED were approached for participation in the study; 1,908 families participated (2.8% of all ED visits during the study period) and were screened for food and housing insecurity. Caregiver surveys included demographic, food and housing insecurity, caregiver/patient health status, and healthcare utilization questions. Caregivers who screened positive for food and/or housing insecurity received printed materials with food and/or housing resources. We analyzed data using descriptive statistics, one-way analysis of variance, and the Pearson chi-squared test.

Results

A total of 1,908 caregivers were surveyed: 416 (21.8%) screened positive for food and/or housing insecurity. Of those who screened positive, 147/416 completed follow-up surveys. On follow-up, 44 (30.0%) no longer screened positive for food and/or housing insecurity, while 15 (10.2%) reported using at least one resource referral. The most frequently reported referral utilization barrier was loss or reported non-receipt of the referral.

Conclusion

This study demonstrates high food- and housing-insecurity rates among families presenting to a pediatric ED, emphasizing the urgency and necessity of screening and intervening in this environment. The food and housing insecurity change between baseline and follow-up reported here and the overall low resource uptake highlights challenges with ED-based screening and intervention efficacy.

Perinatal cumulative risk scores for depression symptoms in young people from the Growing Up in New Zealand longitudinal study

BACKGROUND

Adolescent depression has increased markedly over the last decade and often persists into adulthood with a range of adverse outcomes. Identifying the perinatal risk factors contributing to adolescent depression is crucial to advise early interventions.

METHODS

The study included 4563 young people from the Growing Up in New Zealand (GUiNZ) longitudinal study who completed a questionnaire on depression symptoms at age 12 years (Centre for Epidemiological Studies Depression Scale for Children (CESD-10). Cumulative Risk (CR) scores were created by combining the perinatal risk factors significantly associated with depression symptoms. Then, these CR scores were grouped into three levels and their association with depression symptoms was investigated in univariable and multivariable analyses.

RESULTS

We found a statistically significant association between the CR scores (from one to six perinatal risk factors) and depression score at age 12, compared to the no-risk factor group, suggesting a dose-response relationship. In the adjusted analysis, young people exposed to the lower CR score (1-3 risk factors) had a 0.85 unit increase in depression score (p- < .001), and those exposed to the higher CR (4 ≥ risk factors) had a 1.70 unit increase (p < .001) compared to no perinatal risk factors.

LIMITATIONS

Our model was focused on the perinatal CR score without including the effects of childhood risk factors.

CONCLUSIONS

The perinatal CR score is a valuable approach to identifying the subgroup of young people who are most at risk for depression symptoms. As such, early interventions that simultaneously address multiple perinatal risk factors for depression are recommended.

Clinical features associated with self-reported food insecurity in people with cystic fibrosis

BACKGROUND

Food insecurity (FI) is more prevalent in people with cystic fibrosis (PwCF) than the reported national prevalence, but there are limited data on the relationship between FI and health outcomes in PwCF. The objective of this study was to analyze the relationship between FI in PwCF and pulmonary and nutritional status.

METHODS

We leveraged an electronic cross-sectional survey that ascertained FI status and gave participants the option to link their survey data to their records in the Cystic Fibrosis Foundation Patient Registry (CFFPR). Linear regression and negative binomial models were used to estimate the associations in mean differences between FI and percent predicted FEV1 (ppFEV1), nutritional indices, and hospitalizations.

RESULTS

There were 1,856 respondents, 1,234 (66.5 %) of whom granted permission to link to the CFFPR. FI was present in 352 (28 %) of the respondents. FI was associated with lower ppFEV1 (-6.5; 95 % CI -9.9, -3.1); however, this was no longer statistically significant after adjusting for confounders. FI was independently associated with increased hospitalizations. Higher weight for age was significantly associated with FI in the adjusted model, but there were no significant associations between height for age or absolute weight and body mass index (BMI) in adults.

CONCLUSIONS

FI in PwCF is associated with adverse health outcomes. These results support screening for FI during routine visits. Further studies are needed to investigate causal relationships between FI and adverse clinical outcomes.

Household food insecurity and symptoms of anxiety and depression during pregnancy: Systematic review and meta-analysis

Household food insecurity (HFI) has been related to adverse maternal-child health outcomes and mental health worsening during pregnancy. Few studies evaluated the temporal association between HFI and anxiety and depressive symptoms in pregnant women, and this association remains not completely understood. This study aimed to systematically review the association between HFI and symptoms of depression and anxiety in pregnant individuals. The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022373615). Systematic searches were conducted on 10 electronic databases and grey literature. Two researchers independently conducted the study selection, data extraction process, and the risk of bias assessment. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. Eighteen articles were included for the systematic review, comprising n = 27,882, and a total of 18,987 pregnant individuals aged between 14 and 45 years were included in the meta-analysis. The prevalence of HFI reported in studies ranged from 12.6% to 62.1% (n = 17). The prevalence of depressive and anxiety symptoms ranged from 18% to 49% (n = 11) and 23% to 34% (n = 2), respectively. HFI during pregnancy was associated with increased odds of experiencing symptoms of depression [(OR: 2.52; 95% CI: 2.11-3.02), I2 = 73.23%]. The quality of evidence was very low due to high heterogeneity. Our findings highlighted the association between HFI and depression symptoms during pregnancy. Findings from this study suggest the importance of assessing HFI and mental health during pregnancy.

Breaking the cycle between caregiver mental health and child behavioral issues: Does food insecurity matter?

Food insecurity is a key determinant of not only caregiver's mental health but also children's emotional problems and hyperactivity symptoms. Although substantial studies have explored such a relationship, it is unclear to us whether this relation would vary when considering that caregiver's mental health and aforementioned children's behavioral issues can be the cause and effect of each other. Addressing this research gap is a key to advancing our understanding of how to promote a healthier family dynamic, especially for those facing material needs. This research applies the family stress model to explore how food insecurity affects caregiver psychological distress and child emotional problems and hyperactivity symptoms, while considering the reciprocal relationships between caregiver mental health and these child behavioral issues. Utilizing data from the 2019 Panel Study of Income Dynamic and 2019-2020 Child Development Supplements, this study conducts path analyses applied with propensity score weighting to support causal inference. Results support the family stress model framework, where food insecurity significantly predicts an increase in psychological distress in caregivers, which in turn leads to more severe child emotional problems and hyperactivity symptoms. This study also shows that food insecurity is a risk factor resulting in a reciprocal association between caregiver psychological distress and child emotional problems, where the strength of both directions is similarly harmful to each other. These findings underscore the need to address food insecurity, not only to meet material needs but also to break the harmful cycle of mental health and behavioral issues within families.

Good Friends and Good Neighbors: Social Capital and Food Insecurity in Families with Newborns

OBJECTIVE

To examine the association between social capital and household food insecurity among US families with newborns.

STUDY DESIGN

This cross-sectional analysis used enrollment data from 881 newborn-caregiver dyads at 6 geographically-diverse US academic sites enrolled in the Greenlight Plus Trial, a comparative effectiveness trial to prevent childhood obesity. Ordinal proportional-odds models were used to characterize the associations of 2 self-reported measures of social capital: (1) caregiver social support and (2) neighborhood social cohesion, with household food insecurity after controlling for sociodemographic characteristics.

RESULTS

Among 881 newborn-caregiver dyads (49% Hispanic, 23% non-Hispanic White, 17% non-Hispanic Black; 49% with annual household income <$50 000), food security was high for 75%, marginal for 9%, low for 11% and very low for 4%. In covariate-adjusted analyses, caregivers with a low social support score of 18 had 5 times the odds (aOR = 5.03 95% CI = 3.28-7.74) of greater food insecurity compared with caregivers with a high social support score of 30. Caregivers with a low neighborhood social cohesion score of 10 had nearly 3 times the odds (aOR = 2.87 95% CI 1.61-5.11) of greater food insecurity compared with caregivers with a high neighborhood social cohesion score of 20. These associations remained robust when both social capital measures were included in one model.

CONCLUSIONS

Caregiver social support and neighborhood social cohesion each appear to be inversely associated with food insecurity among US families with newborns. Longitudinal research is needed to determine the directionality of these relationships and whether improving social capital for families with young children reduces household food insecurity.

Food insecurity and BMI are associated with depressive symptoms among adolescents in Yogyakarta province, Indonesia, during the COVID-19 pandemic: a 1-year longitudinal study

The COVID-19 pandemic has presented multifaceted challenges globally, impacting adolescent health. Among these, food security and nutrition are intertwined closely with mental health outcomes. In Indonesia, with its diverse socio-economic landscape, these interconnections may have been exacerbated by the pandemic. This study investigated the relationship between food security, nutrition and adolescent mental health in Indonesia during COVID-19. Longitudinal data were collected from 511 adolescent boys and girls in 2021-2022 in Gunungkidul district, Yogyakarta. Food security was measured using the Household Food Insecurity Access Scale (HFIAS), and the validated Kessler-10 Psychological Distress Scale (K10) was used to measure adolescent depression. Multivariate linear regression and linear mixed-effects regression were employed to explore associations between these variables, while adjusting for sex, age, pubertal status and household income. Overall, food insecurity score was positively associated with depressive symptoms (β: 0·72, 95 % CI 0·52, 0·92), while BMI z-score was inversely associated (β: -0·31, 95 % CI 0·68, -0·03). We found an increase in strength of association between food insecurity and depressive symptoms over time (moderately food-insecure: β: 1·36 (95 % CI -0·10, 2·83) to 4·63 (95 % CI 2·17, 7·09); severely food-insecure: β: 1·89 (95 % CI 0·36, 3·41) to 3·30 (95 % CI 1·50, 5·10). Enhancing food access, improving nutritional status and providing mental health support are crucial components of adolescent health.

Addressing Mental Health and Social Needs in Tandem to Promote Health Equity

Compelling evidence shows that social risks and mental health are intertwined. Pediatric clinicians can maximize the effectiveness of interventions that address mental health concerns by incorporating social risks and social needs screening and interventions. Approaches that elevate the interconnectedness of social risks and mental health require (a) an understanding of the multi-level contextual factors that contribute to patient and family functioning; and (b) a culturally responsive and multidisciplinary clinical practice that targets contextual factors. Supporting families to see the value of concurrently addressing social and mental health needs may be an important step to amplify clinical practice changes.

The effect of the US Child Tax Credit advance payments in 2021 on adolescent mental health: Changes in depression symptoms and suicidality

Objective

Child poverty is associated with poor adolescent mental health. Changes to the Child Tax Credit (CTC) in 2021 in the U.S. were historic and introduced a new model of distributing the credit in advance of tax filing, providing families with stable, supplemental monthly income. This policy shift offers a unique opportunity to examine the mental health effects for adolescents.

Methods

We use electronic health record data from a large pediatric primary care network in Columbus, Ohio, which collected adolescent depression screening scores in real time as the CTC advance payments were introduced. We utilized differences in age of eligibility for the CTC to examine the changes in the probability of depression screening outcomes (positive depression screen, any depression symptom, any suicidal ideation), for adolescents eligible for the credit (turned 18 first quarter of 2022), relative to those not eligible (turned 18 last quarter of 2021) (n = 1,423).

Results

We did not observe a significant association between the policy change and study outcomes in the overall sample. However, the percentage of adolescents with a positive depression screen significantly declined for Non-Hispanic Black (13.4 percentage point reduction, p = 0.01) and publicly insured (9.7 percentage point reduction, p = 0.04) adolescents.

Conclusions

Our findings suggest reductions in depression symptoms for subgroups of adolescents who were age-eligible for the CTC compared to their counterparts who were not eligible. The CTC advance payments were a brief experiment in universal basic income and may offer a policy solution for addressing both poverty and a growing adolescent mental health crisis.

A new approach to a wicked problem: development of a cross-sector community-centered learning network to tackle childhood food inequity

Food insecurity is a complex societal problem that disproportionately impacts households with children and those led by minoritized populations, with negative impacts on health across the life course. System to Achieve Food Equity adapted the learning systems model, used to address similarly complex problems, to tackle food insecurity at a neighborhood level. SAFE, born out of the COVID-19 pandemic, leverages a family-centered, community-based, cross-sector network fundamentally aimed at changing the food system so that all children in Cincinnati have the food they need to thrive. Through the following principles, Community-Led Network, Co-Production with Community, Equitable Sustainability, Learning to Learn Together, Distributing Leadership and Power, and Shared Data and Governance, SAFE has grown to over 300 individuals and 100 organizations, funded 9 novel interventions, distributed over 270,000 meals, and created a collaborative of motivated like-minded stakeholders. Future work includes improved data collection and sharing, support for increased stakeholder engagement and greater distribution of leadership and power, advocacy for policy change, refining measurement tools of network maturity for community settings, and collaboration with other efforts that contribute to food security indirectly.

Focusing attention on the important association between food insecurity and psychological distress: a systematic review and meta-analysis

BACKGROUND

Food insecurity has involved more than 750 million individuals worldwide. The association of food insecurity with socio-economic factors is also undeniable demand more consideration. Food insecurity will become a global priority by 2030. This systematic review and meta-analysis examined current literature concerning the association between food insecurity and psychological distress.

METHODS

Relevant researches were identified by searching databases including PubMed, EMBASE, Scopus, and Web of Science, ProQuest, and Cochrane Library up to June 2024 without language limitation. Then a snowball search was conducted in the eligible studies. The quality assessment was made through Newcastle-Ottawa Scale.

RESULTS

Data were available from 44 cross-sectional articles for systematic review and 17 eligible articles for meta-analysis with 2,267,012 and 1,953,636 participants, respectively. Findings support the growing segment of literature on the association between food insecurity and psychological distress. The highly represented groups were households with low income. Psychological and diabetic distress was directly associated with food insecurity as it increased the odds of distress to 329% (OR: 3.29; 95% CI: 2.46-4.40). Sleep problems, anxiety, depression, lower life satisfaction, obesity, and a higher rate of smoking were among the secondary outcomes.

CONCLUSION

Food insecurity was a common stressor that can have a negative impact on psychological well-being and even physical health. The findings should be considered in the public health and making policy-making process.

Translational science approaches for food insecurity research

Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.

Food insecurity in children with heart disease

PURPOSE OF REVIEW

This review discusses the epidemiology of food insecurity (FI) and its consequences in children with congenital heart disease. We aimed to highlight current interventions to screen and address food insecurity in the context of pediatric cardiology and to offer strategies for providers to engage in this meaningful work.

RECENT FINDINGS

Food insecurity is consistently associated with poor health outcomes in children. In the United States, 17.3% of households with children experience FI. Nonwhite and single-parent families are disproportionately affected. Interestingly, because of a low-quality diet, FI is associated with childhood obesity, putting affected children at increased risk for cardiovascular morbidity and mortality over time. Children with congenital heart disease are susceptible to poor outcomes due to unique altered metabolic demands, increased risk for growth impairment, frequent need for specialized feeding regimens, and additional morbidity associated with heart surgery in underweight children.

SUMMARY

Today, the burden of screening for FI is most commonly placed on general pediatricians. Considering the importance of nutrition to cardiovascular health and general wellbeing, and the ease with which screening can be performed, pediatric cardiologists and other subspecialists should take a more active role in FI screening.

Food insecurity and quality of life in patients with sickle cell disease

Little is known about the relationship between quality of life (QOL) and food insecurity (FI) among patients with sickle cell disease (SCD). We hypothesized FI is associated with lower QOL in children and young adults with SCD. Overall (N = 99), 22% screened positive for FI. Supplemental Nutrition Assistance Program (SNAP) enrollment was 50 and 71% among people from food secure and FI households, respectively. A higher FI score was correlated with lower overall QOL (r = -0.22, p = .03), specifically lower QOL in worry and communication domains. Interventions for FI beyond SNAP may be important for QOL among people living with SCD.

Examining parents' experiences and challenges of feeding preschool children with avid eating behaviour

Avid eating behaviours, including greater responsiveness to food cues and emotional over-eating, have been linked to child overweight and obesity. Parental feeding practices are modifiable components of a child's food environment and may be key levers for behaviour change in tailored interventions to support parents of children with avid eating behaviour. However, there is a lack of research examining parents' experiences in this context. This study aimed to explore parents' experiences of feeding children with avid eating behaviour and to understand any challenges experienced in this context. Semi-structured interviews with parents (N = 15) of a preschool child (3-5 years) identified as having an avid eating behaviour profile explored how children's avid eating manifests, the parental feeding practices used to manage avid eating, and the perceived effectiveness of these strategies. Data were analysed using reflexive thematic analysis. Four core themes were generated. Theme one, 'Have they got worms? Children's insatiable hunger', captures parents' interpretation of the complex ways in which avid eating behaviour manifests. Theme two, 'Parenthood as a duty', illustrates how parents' perceived responsibilities shape their feeding practices. Theme three, 'Lifelong habits', captures parents' use of responsive feeding practices to support children's healthy relationship with food. Theme four, 'Picking battles', captures the structure- and coercive-based feeding strategies commonly used to manage children's avid eating. This novel study provides an in-depth understanding of the complex ways that children's avid eating behaviour manifests, and the strategic and creative parental feeding practices used to manage these behaviours. Such findings are valuable for informing the development of future support resources for parents/caregivers to help their children with avid eating behaviours to develop a healthy relationship with food.

The Intersection of Food Security and Mental Health in the Pursuit of Sustainable Development Goals

Food insecurity, a multifaceted global challenge, intertwines with mental health concerns, necessitating nuanced strategies for sustainable solutions. The intricate web of challenges posed by these intersections has made it imperative to delineate a strategic way forward, incorporating solutions and robust policy recommendations. This study aims to comprehensively examine the intricate relationship between food security and its intersection with mental health on a global scale, offering insights into case studies, responses, and innovative approaches to inform effective strategies for addressing these pressing challenges. This study involved an analysis of a literature search, mainly between 2013 and 2023, with an updated addition of relevant 2024 studies. Examining responses across regions unveils varied interventions, from targeted social safety net programs in West Africa to technology-driven solutions in Asia. Success stories, such as Ghana's sustainable agricultural practices and Canada's income transfer programs, underscore the efficacy of multifaceted approaches. Innovative initiatives like community food programs offer promising alternatives to traditional food banks. Furthermore, international cooperation and policy innovations, exemplified by the European Union's "Farm to Fork Strategy", demonstrate the potential for collective action in addressing food insecurity. By prioritizing integrated strategies, global collaboration, and evidence-based policymaking, we lay the groundwork for sustainable development where communities thrive nutritionally and mentally. We emphasize continuous research and evaluation and incorporating mental health support into community programs to pave the way for a future where communities are not only food-secure but also mentally resilient.

Cross-sectional analysis of the association between household food insecurity and mental health conditions in children aged 5-11 years in Canada

BACKGROUND

Children living in food insecure households have poorer mental health outcomes compared with their food-secure peers; however, the relationship between the severity of food insecurity and diagnosed mental health conditions in young children remains unknown. This study examined the association between household food insecurity and reported diagnosed mental health conditions among children aged 5-11 years in Canada.

METHODS

This study included 16 216 children aged 5-11 years living in Canada, from the 2019 Canadian Health Survey on Children and Youth. We measured household food insecurity using the Household Food Security Survey Module. We measured diagnosed mental health conditions by parent/caregiver report of health professional-diagnosed anxiety, depression, autism spectrum disorder or attention-deficit/hyperactive disorder. We developed a multivariable logistic regression model to assess the association between severities of food insecurity and mental health, controlling for potentially confounding variables.

RESULTS

17.0% of children lived in households reporting some level of food insecurity (5.4% marginal, 8.0% moderate and 3.6% severe). The prevalence of at least one diagnosed mental health condition in the same population was 10.9%. After adjusting for sociodemographic characteristics, children from marginal, moderate and severe food insecure households had a 1.39 (95% CI 0.99 to 1.97), 1.46 (95% CI 1.13 to 1.89) and 1.67 (95% CI 1.18 to 2.35) increased odds of having a diagnosed mental health condition, respectively.

CONCLUSION

Household food insecurity is associated with an increased presence of diagnosed mental health conditions in children aged 5-11 years. This study adds to the body of research showing that social and economic inequities, including household food insecurity, negatively impact the health of children.

Child meal support program, food and nutrition insecurity, and health among Korean children

BACKGROUND

Korea's child meal support program (CMSP) aims to reduce food and nutrition insecurity (FNI) and improve health among children from low-income households.

AIM

We examined the impact of different types of CMSP on children's FNI and health in Korea, analyzing meal frequency and healthful food consumption (FNI), and general health and depression (health) among child meal card (CMC) and facility meal service (FMS) participants compared with nonparticipants.

METHODS

The 2018 Comprehensive Survey on Korean Children data were analyzed. Precisely, 847 children from low-income households aged 9-17 were categorized into CMC (n = 331), FMS (n = 209), and income-eligible nonparticipants (n = 307). Propensity score-weighted generalized linear models assessed CMSP's impact on FNI and health. Stratified generalized linear models examined heterogeneity in FNI-health associations by CMSP status.

RESULTS

CMC participants reported more frequent breakfast consumption (odds ratio [OR] = 0.662, p < 0.05) but poorer self-rated general health (OR = 1.890, p < 0.05); FMS participants were less likely to have three meals (OR = 1.814, p < 0.05), fruits and vegetables (OR = 2.194, p < 0.001), and protein-rich foods daily (OR = 1.695, p < 0.05) than nonparticipants. Health risks associated with healthful food consumption and meal frequency were more pronounced among CMC and FMS/nonparticipants, respectively.

CONCLUSION

CMSP had a limited impact on reducing FNI and improving health among children from low-income households. CMC appeared more effective than FMS in alleviating FNI, notwithstanding potential health concerns. Food assistance programs should seek comprehensive enhancements in children's food and nutrition security and health.

Rural-urban differences in social and emotional protective factors and their association with child health and flourishing

BACKGROUND

Children in rural communities experience higher mortality rates and less access to health care services than those in urban communities. Protective factors like social support also vary by geography, but their contribution to differences in child health is understudied. Understanding geographic variation in protective health factors could provide insight into their impact on health and guide future intervention strategies.

RESEARCH OBJECTIVE

To examine protective factors' association with child flourishing and child health status in rural and urban communities.

METHODS

Publicly available data from the National Survey of Children's Health, 2018-2021, with nonmissing geographic data (N = 150,493) were used to assess the relationship between protective factors and child flourishing and health by rurality. Multivariate survey-weighted probit models examined these relationships, adjusting for child and caregiver characteristics.

FINDINGS

More than a third of children were not flourishing, according to parental report. An estimated 62% of rural children were flourishing compared to 66% of urban children (P<0.001). Urban caregivers also were more likely to report better adult mental and physical health status. Nevertheless, rural children were reported to receive more social support than urban children, while their caregivers reported more emotional support and living in supportive and safe neighborhoods (P<0.001). Rural caregivers reported more support from places of worship and less from counselors/other mental health care providers than urban caregivers.

CONCLUSIONS

Despite higher reported caregiver emotional support and child social support, fewer rural children are flourishing. Health systems and community organizations able to leverage these existing social and emotional protective factors in rural communities could help close this gap.

Household Health-Related Social Needs in Newborns and Infant Behavioral Functioning at 6 Months

Importance

Dysfunctional patterns of behavior during infancy can predict the emergence of mental health disorders later in childhood. The Baby Pediatric Symptom Checklist (BPSC) can identify indicators of behavioral disorders among children aged 0 to 18 months. Understanding the association of early health-related social needs (HRSNs) with poor infant behavioral functioning can inform interventions to promote early childhood mental well-being.

Objective

To examine the association between household HRSNs in the first 4 months of life and BPSC results at 6 months.

Design, Setting, and Participants

This was a retrospective cohort analysis of longitudinal electronic health record data. Covariates were selected based on the biopsychosocial ecological model. Logistic regression analyses examined the association of HRSN domains and the number of HRSNs with the 6-month BPSC outcomes. Participants were recruited from 6 primary care clinics within 1 health system. Children aged 5 to 8 months who were evaluated for 6-month well-child visits between March 30, 2021, and June 30, 2022, were included in the study.

Exposure

Responses to the first HRSN screening tool that a caregiver completed for infants between 0 and 4 months of age. HRSN domains were examined individually and as the number of positive HRSNs.

Main Outcome and Measures

BPSC screen identified for clinical review due to 1 or more elevated subscales (inflexibility, irritability, and difficulty with routines) at 6 months.

Results

A total of 1541 children (mean [SD] age, 6.1 [0.5] months; 775 female [50.3%]) were included in the study. A total of 405 children (26.3%) had a BPSC screen identified for clinical review, and 328 caregivers (21.3%) reported at least 1 HRSN. Food insecurity (174 [11.3%]) and benefits issues (169 [11.0%]) were the most frequently reported HRSN. Children in households with food insecurity had statistically significant higher odds of inflexibility (adjusted odds ratio [aOR], 1.73; 95% CI, 1.14-2.63), difficulty with routines (aOR, 1.64; 95% CI, 1.05-2.57), and irritability (aOR, 1.86; 95% CI, 1.13-3.08) than children in households without food insecurity. Children in households with benefits issues had statistically significant higher odds of difficulty with routines (aOR, 1.70; 95% CI, 1.10-2.65) and irritability (aOR, 1.70; 95% CI, 1.03-2.82). Children in households with 2 or more HRSNs had consistently higher odds of having a BPSC screen identified for clinical review (aOR, 2.16; 95% CI, 1.38-3.39) compared with children with no HRSNs.

Conclusions and Relevance

Results of this cohort study suggest that household food insecurity, benefits issues, and the number of HRSNs were significantly associated with a BPSC screen identified for clinical review at 6 months of age. These findings highlight the urgency of intervening on HRSNs in the newborn period to prevent adverse infant behavioral outcomes.

Food Insecurity and Mental Distress Among WIC-Eligible Women in the United States: A Cross-Sectional Study

BACKGROUND

Women living in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible households may be pregnant or breastfeeding. Stress during pregnancy and breastfeeding may influence women's mental health making them more vulnerable to higher rates of food insecurity (FI).

OBJECTIVE

Determine whether or not FI is associated with moderate-to-severe mental distress among women living in WIC-eligible households, and whether or not the strength of the association differs among WIC participants compared with eligible nonparticipants with low income.

DESIGN

Cross-sectional data from the 2011-2018 National Health Interview Survey were utilized.

PARTICIPANTS/SETTING

A total of 7,700 women living in WIC-eligible households with at least one child were analyzed.

MAIN OUTCOME MEASURES

Moderate-to-severe mental distress was measured using the validated K6 nonspecific psychological distress scale. FI was measured using the 10-item, US Adult Food Security Survey Module.

STATISTICAL ANALYSES PERFORMED

Multivariate logistic regression was used to examine the association between FI and mental distress. The conditional effects of WIC participation were examined by including interaction terms for FI and WIC participation as well as by stratifying the sample by WIC participation.

RESULTS

Among women in WIC-eligible households, FI was associated with moderate-to-severe mental distress in a dose-response fashion: compared with those who were food secure, the adjusted odds of moderate-to-severe mental distress were 1.8 times higher among those with marginal food security (adjusted odds ratio [AOR] 1.83, 95% CI 1.50 to 2.23), 2.1 times higher among those with low food security (AOR 2.14, 95% CI 1.76 to 2.60), and 3.7 times higher among those with very low food security (AOR 3.73, 95% CI 2.95 to 4.71). The interaction between FI and WIC participation was not significant, with similar associations between FI and mental distress among WIC participants and nonparticipants.

CONCLUSIONS

Among this nationally representative sample of women in WIC-eligible households, increasing severity of food insecurity was associated with poor mental health among WIC participants and nonparticipants. WIC participation was not observed to moderate the association between FI and mental distress. More research should consider including mental health screening at WIC clinic visits to enable early identification and referral for care.

Suicide in a Colombian indigenous community: Beyond mental illness

BACKGROUND

Among the causes associated with suicide there are social factors such as forced displacement has been described and health factors in general that have an impact on pediatric mental health.

AIMS

To describe clinical and psychosocial factors, and their relationship with suicidal behavior in a Colombian indigenous community.

PARTICIPANTS AND SETTING

The mean age were 9.23 years old, 53.7% male and 46.3% female.

METHOD

Mixed approach study. A thematic analysis was carried out with the youth of the community to investigate emotional aspects. A descriptive cross-sectional study was carried out and correlations between variables were made.

RESULTS

Correlations were found between suicidal behavior and medical findings. When comparing the mental health disorders and nutritional problems, statistically significant differences were found in the Suicide Risk domain (<.001). This was reaffirmed in the thematic analysis, where factors such as migration and difficulty understanding the language are highlighted as related to suicidal behavior in the pediatric population.

CONCLUSIONS

Suicidal behavior should not be approached solely from psychopathology. Hunger, the weakening of one's own culture, armed conflict, migration, and other clinical conditions are found to be associated with suicidal behavior.

News media framing of food poverty and insecurity in high-income countries: a rapid review

Food poverty and insecurity have become a public health emergency in many high-income countries. News media coverage can shape public and political views towards such issues. This rapid review synthesizes the evidence on how food poverty and insecurity are represented in the news media. Peer-reviewed publications were accessed through three electronic databases, with reference lists of all included studies screened. Primary research studies conducted in high-income countries and published in English since 1995 were included, with no restrictions on study methods. A combination of deductive coding to Entman's framing theory and inductive analysis was used. Ten studies, mostly rated as low quality, were included in the review. Newspapers were the only type of news media examined. The findings showed a largely absent nuanced understanding of food poverty and insecurity, with the problem often defined by food bank use and the consequences mainly focused on physical health. The causes were mostly attributed to structural factors, with the solutions largely focused on charitable food aid. The discourse of recipient (un)deservingness of food aid was evident. Articles often contained views from government officials and charities, with individuals' experiences of food poverty and insecurity largely absent. The findings of this review highlight that a major shift in print media discourse on food poverty and insecurity is required. More balanced and critical news reporting is required to present a more realistic picture of food poverty and insecurity, including its multi-dimensional nature, limitations of food charity and the need for structural solutions to this important issue.

Association between food insecurity and depressive symptoms among adolescents aged 12-15 years from 22 low- and middle-income countries

Food insecurity may be a risk factor for depression in adolescents. However, data on this topic from low- and middle-income countries (LMICs) are scarce, despite food insecurity being most common in LMICs. Therefore, we aimed to examine the association between food-insecurity and depressive symptoms among school-going adolescents from 22 LMICs. Cross-sectional data from the Global school-based Student Health Survey were analyzed. Self-report measures assessed past 12-month depressive symptoms and past 30-day food insecurity (hunger). Multivariable logistic regression and meta-analysis were conducted to assess associations. Data on 48,401 adolescents aged 12-15 years were analyzed [mean (SD) age 13.8 (0.9) years; 51.4 % females]. The prevalence of depressive symptoms was 29.3 %, and those of moderate and severe food insecurity were 45.0 and 6.3 %, respectively. After adjustment for potential confounders, compared to no food insecurity, the pooled OR (95 %CI) of moderate and severe food insecurity were 1.36 (1.30-1.42) and 1.81 (1.67-1.97), respectively. The level of between-country heterogeneity was low. Food insecurity was associated with significantly higher odds for depressive symptoms among adolescents in LMICs. Policies to address food insecurity may also help prevent depression in this population, pending future longitudinal research.

A Pilot Study Examining the Association of Parental Stress and Household Food Insecurity with Dietary Quality in Pre-School-Aged Children

Adequate dietary quality is necessary for children's appropriate development and may be influenced by family factors. This study with 24 healthy 3-5-year-old children assessed the associations of parental stress and household food insecurity (HFI) with a child's dietary quality. Parents completed three 24 h dietary recalls, and the Healthy Eating Index was calculated to assess dietary quality. Parents also completed a questionnaire, including The Perceived Stress Scale (assessing overall parental stress) and the Hunger Vital Sign screen (assessing HFI). Children's height/weight were measured, and BMIz was calculated. Separate multivariable linear regression models assessed the association of dietary quality components with HFI and parental stress, adjusting for household income, child sex, and child BMI z-score. In bivariate analyses, children with HFI consumed more added sugars, and parental stress was associated with the child's greens/beans intake. In multivariable analysis, HFI was associated with lower total protein scores and higher added sugar intake, while parental stress was associated with lower greens/beans intake. Higher household income was associated with higher total vegetable and sodium intake, and children with a higher BMIz had a lower total protein intake. Parental stress and HFI can impact a child's dietary quality; providers should counsel families on strategies to improve diet quality.

Food and Nutrition Security Among Households With Children in North Carolina: Challenges, Opportunities, and Potential Policy Solutions

In North Carolina, childhood food and nutrition insecurity are persistent problems. This article explores challenges, highlights potential opportunities, and proposes policy solutions for food and nutrition insecurity among households with children. North Carolina is poised to ensure adequate, healthy, affordable, and accessible nutrition for its youngest residents.

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.

Scoping review protocol exploring the relationship between food insecurity, mental health and diet intake among adolescents across the globe

INTRODUCTION

Studies, exploring the effect of food insecurity on physical and mental health, have shown that food insecurity is associated with lower self-reports of physical and mental health. With the COVID-19 pandemic, food insecurity has increased leading to higher risks of poor mental health. Despite evidence of the negative implications of food insecurity on mental health, there is a paucity of research on these variables for adolescents specifically. The current evidence shows there is a gap in adolescent centred research linking mental health and food insecurity globally. Adolescence is a crucial period of development where habits, nutritional inadequacies linked to food insecurity and mental health problems formed due to these inadequacies can be conveyed into adulthood. The aim of this study is to systematically scope the literature exploring the relationship between mental health, food (in)security and/or diet intake of adolescents.

METHODS

This review will be guided by Arksey and O'Malley's extended framework. The search strategy was developed by two of the authors and will be used to search literature from January 2012 to December 2022 in PubMed, Academic search complete, PsychARTICLES, Google, ScienceDirect, Scopus and Web of science core collection. Searching published and unpublished literature will be done in the chosen databases. References used in included literature will be reviewed for additional studies/sources. Articles will be assessed for eligibility by two reviewers, and any discrepancies reviewed by a third reviewer. The inclusion and exclusion criteria will be used for screening. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram will be used to document the selection process. A narrative summary and descriptive analysis will be used to summarise and report the extracted data.

ETHICS AND DISSEMINATION

Approval for this study has been granted by the University of the Western Cape Biomedical Research Ethics Committee (BM21/8/3). Strict measures will be followed to ensure methodological rigour.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

IMPACT

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

War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children

Altered secretion of cortisol, the primary effector of the hypothalamus-pituitary-adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents. Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6-18 years) and their caregiver. This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon. The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of war-related events experienced. This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.

Household food insecurity risk indices for English neighbourhoods: Measures to support local policy decisions

BACKGROUND

In England, the responsibility to address food insecurity lies with local government, yet the prevalence of this social inequality is unknown in small subnational areas. In 2018 an index of small-area household food insecurity risk was developed and utilised by public and third sector organisations to target interventions; this measure needed updating to better support decisions in different settings, such as urban and rural areas where pressures on food security differ.

METHODS

We held interviews with stakeholders (n = 14) and completed a scoping review to identify appropriate variables to create an updated risk measure. We then sourced a range of open access secondary data to develop an indices of food insecurity risk in English neighbourhoods. Following a process of data transformation and normalisation, we tested combinations of variables and identified the most appropriate data to reflect household food insecurity risk in urban and rural areas.

RESULTS

Eight variables, reflecting both household circumstances and local service availability, were separated into two domains with equal weighting for a new index, the Complex Index, and a subset of these to make up the Simple Index. Within the Complex Index, the Compositional Domain includes population characteristics while the Structural Domain reflects small area access to resources such as grocery stores. The Compositional Domain correlated well with free school meal eligibility (rs = 0.705) and prevalence of childhood obesity (rs = 0.641). This domain was the preferred measure for use in most areas when shared with stakeholders, and when assessed alongside other configurations of the variables. Areas of highest risk were most often located in the North of England.

CONCLUSION

We recommend the use of the Compositional Domain for all areas, with inclusion of the Structural Domain in rural areas where locational disadvantage makes it more difficult to access resources. These measures can aid local policy makers and planners when allocating resources and interventions to support households who may experience food insecurity.