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Logie CH, Newman PA, Admassu Z, MacKenzie F, Chakrapani V, Tepjan S, Shunmugam M, Akkakanjanasupar P. Associations between water insecurity and mental health outcomes among lesbian, gay, bisexual, transgender and queer persons in Bangkok, Thailand and Mumbai, India: Cross-sectional survey findings. Glob Ment Health (Camb) 2024; 11:e31. [PMID: 38572259 PMCID: PMC10988155 DOI: 10.1017/gmh.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/29/2023] [Accepted: 02/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background Water insecurity disproportionally affects socially marginalized populations and may harm mental health. Lesbian, gay, bisexual, transgender and queer (LGBTQ) persons are at the nexus of social marginalization and mental health disparities; however, they are understudied in water insecurity research. Yet LGBTQ persons likely have distinct water needs. We explored associations between water insecurity and mental health outcomes among LGBTQ adults in Mumbai, India and Bangkok, Thailand. Methods This cross-sectional survey with a sample of LGBTQ adults in Mumbai and Bangkok assessed associations between water insecurity and mental health outcomes, including anxiety symptoms, depression symptoms, loneliness, alcohol misuse, COVID-19 stress and resilience. We conducted multivariable logistic and linear regression analyses to examine associations between water insecurity and mental health outcomes. Results Water insecurity prevalence was 28.9% in Mumbai and 18.6% in Bangkok samples. In adjusted analyses, in both sites, water insecurity was associated with higher likelihood of depression symptoms, anxiety symptoms, COVID-19 stress, alcohol misuse and loneliness. In Mumbai, water insecurity was also associated with reduced resilience. Conclusion Water insecurity was common among LGBTQ participants in Bangkok and Mumbai and associated with poorer well-being. Findings signal the importance of assessing water security as a stressor harmful to LGBTQ mental health.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Peter A. Newman
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Pakorn Akkakanjanasupar
- Department of Educational Policy, Management, and Leadership, Faculty of Education, Chulalongkorn University, Bangkok, Thailand
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Burns PA, Mutunga C. Addressing the Impact of Climate Change on Sexual and Reproductive Health Among Adolescent Girls and Young Women in Low- and Middle-Income Countries. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:GHSP-D-23-00374. [PMID: 38365281 PMCID: PMC10906547 DOI: 10.9745/ghsp-d-23-00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
There is an urgent need to better understand the role of climate change on sexual and reproductive health outcomes, particularly among adolescent girls and young women in low- and middle-income countries. Stakeholders at all levels should apply a rights-based, gendered approach to climate action and adaptation.
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Affiliation(s)
- Paul A Burns
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
- U.S. Agency for International Development, Bureau for Global Health, Office of Population and Reproductive Health, Division of Research, Technology and Utilization, Washington, DC
- American Association for the Advancement of Science, Washington, DC
| | - Clive Mutunga
- BUILD (Building Capacity for Integrated Family Planning & Reproductive Health and Population, Environment and Development Action), The African Institute for Development for Policy, Lilongwe, Malawi
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Nutor JJ, Okiring J, Yeboah I, Thompson RGA, Agbadi P, Ameyaw EK, Getahun M, Agbadi W, Hoffmann TJ, Weiser SD. Association between water insecurity and antiretroviral therapy adherence among pregnant and postpartum women in Greater Accra region of Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002747. [PMID: 38190403 PMCID: PMC10773961 DOI: 10.1371/journal.pgph.0002747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) can substantially reduce morbidity and mortality among women living with HIV (WLWH) and prevent vertical transmission of HIV. However, in sub-Saharan Africa (SSA), more than 50% of new mothers discontinue ART and HIV care after childbirth. The role of water insecurity (WI) in ART adherence is not well-explored. We examined the relationship between WI and ART adherence among pregnant and postpartum WLWH in Greater Accra region of Ghana. METHODS Using a cross-sectional survey, we recruited 176 pregnant and postpartum WLWH on ART across 11 health facilities. We examined the association between WI (measured using the Household Water Insecurity Experience Scale, and categorized as moderate and severe WI compard to low WI) and poor ART adherence (defined as scoring a below average observed CASE index score). Bivariate analysis was performed using chi-square test followed by multivariate logistic regression models. We included all variables with p-values less than 0.20 in the multivariate analysis. RESULTS Most (79.5%) of the pregnant and postpartum WLWH enrolled on ART, were urban residents. Over 2/3 were aged 30 years and older. Overall, 33.5% of respondents had poor ART adherence. Proportion of poor ART adherence was 19.4% among those with low WI, 44.4% in those with moderate WI, and 40.0% among those with high WI. Respondents with moderate household water insecurity had a greater odds of reporting poor ART adherence, as compared to those with low water insecurity (adjusted Odds ratio (aOR) = 2.76, 95%CI: 1.14-6.66, p = 0.024), even after adjusting for food insecurity. Similarly, respondents with high WI had a greater odds of reporting poor ART adherence, as compared to those with low water insecurity (aOR = 1.49, 95%CI: 0.50-4.48, p = 0.479), even after adjusting for food insecurity. CONCLUSION Water insecurity is prevalent among pregnant and postpartum WLWH and is a significant risk factor for poor ART adherence. Governments and other stakeholders working in HIV care provision should prioritize water security programming for WLWH along the HIV care continuum.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Isaac Yeboah
- Institute of Work Employment and Society, University of Professional Studies, Accra, Ghana
| | - Rachel G. A. Thompson
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
- Africa Interdisciplinary Research Institute, Accra, Ghana
| | - Pascal Agbadi
- Department of Sociology and Social Science Policy, Lingnan University, Hong Kong, China
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong, China
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Wisdom Agbadi
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Push Aid Africa, Accra, Ghana
| | - Thomas J. Hoffmann
- Department of Epidemiology and Biostatistics, and Office of Research, School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco California, United States of America
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Owuor PM, Awuor DR, Ngave EM, Young SL. "The people here knew how I used to live, but now I have to start again:" Lived experiences and expectations of the displaced and non-displaced women affected by the Thwake Multipurpose Dam construction in Makueni County, Kenya. Soc Sci Med 2023; 338:116342. [PMID: 37922742 DOI: 10.1016/j.socscimed.2023.116342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Dam construction and associated disruptive activities such as population displacement can have significant societal consequences, especially for those socially and economically disadvantaged. Though community-level health and social consequences of displacements have been documented, there is little understanding of the individual-level consequences and intra-household gendered dynamics. OBJECTIVE/METHODS We sought to explore the experiences and expectations of displaced (n = 30) and non-displaced (n = 20) women in Makueni County, Kenya, where Kenya's second largest dam, Thwake Multipurpose Dam, is being constructed. We used qualitative techniques, including photo-elicitation interviews, go-along interviews, key informant interviews, and participant observation, to understand the lived experiences of women affected by the dam construction processes and their associated disruptions. RESULTS We found that both displaced and non-displaced women experienced the impacts of dam construction in four areas, i.e., economic (income loss), health (hearing damage), social (disrupted social networks), and environmental (flooding) domains. Though both groups described adverse effects, the displaced women perceived worse economic and social outcomes than non-displaced ones. Further, older and married women in both groups had the worst lived experiences and negative perceptions about the consequences for social well-being, e.g., loss of cultural identity, land ownership, and access to important religious sites. Changes in livelihood also transformed gender roles as women assumed economic responsibilities to cushion their families from hunger. CONCLUSION Development projects such as dams negatively impact the host community-displaced and the non-displaced experience adverse health, social, and environmental effects. However, poor women who are smallholder farmers bear the greatest burden. Assessment of individual-level experiences and intrahousehold dynamics might enhance our understanding of the biosocial outcomes of these consequences. Therefore, integrative biosocial approaches should be considered when examining the impacts of dam construction.
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Affiliation(s)
- Patrick Mbullo Owuor
- Department of Anthropology, Northwestern University, 1819 Hinman Avenue, Evanston, IL, 60208, USA; Department of Anthropology, Wayne State University, 656 W. Kirby St., Detroit, MI, 48202, USA.
| | - Diana Ross Awuor
- Department of Management Science and Project Planning, Nairobi University, Kenya
| | - Emily Mwende Ngave
- Faculty of Science, Technology, Engineering & Mathematics-Engineering & Innovation, Open University, UK
| | - Sera L Young
- Department of Anthropology, Northwestern University, 1819 Hinman Avenue, Evanston, IL, 60208, USA; Institute for Policy Research, Northwestern University, 617 Library Pl, Evanston, IL, 60201, USA
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Celeste-Villalvir A, Then-Paulino A, Armenta G, Jimenez-Paulino G, Palar K, Wallace DD, Derose KP. Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional counselling intervention for people with HIV in the Dominican Republic. Public Health Nutr 2023; 26:3134-3146. [PMID: 37905447 PMCID: PMC10755388 DOI: 10.1017/s1368980023002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. DESIGN Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. SETTING An HIV clinic in the northwest-central part of the Dominican Republic. RESULTS The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. CONCLUSION An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.
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Affiliation(s)
- Alane Celeste-Villalvir
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
| | - Amarilis Then-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
| | - Gipsy Jimenez-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Kartika Palar
- University of California, San Francisco, Department of Medicine, San Francisco, CA94143, USA
| | - Deshira D Wallace
- University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC27599, USA
| | - Kathryn P Derose
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
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Toivettula A, Varis O, Vahala R, Juvakoski A. Making waves: Mental health impacts of inadequate drinking water services - From sidenote to research focus. WATER RESEARCH 2023; 243:120335. [PMID: 37516073 DOI: 10.1016/j.watres.2023.120335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 07/31/2023]
Abstract
The paramount significance of the harmful impacts of poor drinking water services on physical health have been recognized for decades. Besides, over the past twenty years, an additional body of literature on their negative mental health impacts has emerged. With this brief review, we summarise the findings of the scholarship to advance addressing overall health (physical, mental, and social) in the water sector. We furthermore review the key policy documents of this field with a focus on mental health aspects and give recommendations for practitioners and decision-makers on addressing mental health in water service delivery. We reviewed the existing published works (42) assessing psychological impacts of deficient drinking water services in low-income settings. We then identified and compared the different mechanisms causing negative mental health outcomes described in them. For these purposes, we used a water insecurity experience -model and the vulnerability-stress model of clinical psychology. Next, we probed key international and national guiding documents of the water sector to analyse how mental health issues resulting from poor services are addressed today. We found that according to the literature, poor quality and quantity of water was predictably one of the most important psychosocial stressors to users. Surprisingly, however, various kinds of water-service-related inequalities (e.g. between genders, communities or socio-economic groups) showed up as equally significant stressors. Our analysis with the vulnerability-stress model furthermore indicates that insufficient drinking water services may predispose to common mental disorders particularly through external stress. Existing field guidelines have evolved to highlight the values of non-discrimination and participation, whilst mental health aspects remain ignored. This should not be the case. Therefore, practices for addressing mental health effectively in documentation and water service development should be further researched. But already in the light of the existing literature, we urge stakeholders to focus more on the negative mental health impacts of unequal service provision for users and nearby people left without improved services.
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Affiliation(s)
- A Toivettula
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland.
| | - O Varis
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland
| | - R Vahala
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland
| | - A Juvakoski
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland.
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Kimutai JJ, Lund C, Moturi WN, Shewangizaw S, Feyasa M, Hanlon C. Evidence on the links between water insecurity, inadequate sanitation and mental health: A systematic review and meta-analysis. PLoS One 2023; 18:e0286146. [PMID: 37228056 DOI: 10.1371/journal.pone.0286146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals. OBJECTIVE To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally. DATA SOURCES Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023. STUDY ELIGIBILITY CRITERIA Only quantitative studies were included. The exposure was water insecurity and or inadequate sanitation. The outcome was common mental disorders (CMD: depression or anxiety), mental distress, mental health or well-being. There was no restriction on geographical location. PARTICIPANTS General population or people attending health facilities or other services. EXPOSURE Water insecurity and/ or inadequate sanitation. RISK OF BIAS The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies. SYNTHESIS OF RESULTS A meta-analysis was conducted using a random effects statistical model. RESULTS Twenty-five studies were included, with 23,103 participants from 16 countries in three continents: Africa (Kenya, Ethiopia, Ghana, Uganda, South Africa, Malawi, Mozambique, and Lesotho), Asia (Nepal, Bangladesh, India, and Iran) and the Americas (Brazil, Haiti, Bolivia and Vietnam). There was a statistically significant association between water insecurity and CMD symptoms. Nine studies reported a continuous outcome (5,248 participants): overall standardized mean difference (SMD = 1.38; 95% CI = 0.88, 1.87). Five studies reported a binary outcome (5,776 participants): odds ratio 5.03; 95% CI = 2.26, 11.18. There was a statistically significant association between inadequate sanitation and CMD symptoms (7415 participants), overall SMD = 5.36; 95% CI = 2.51, 8.20. LIMITATIONS Most of the included studies were cross-sectional which were unable to examine temporal relationships. CONCLUSIONS Water insecurity and inadequate sanitation contribute to poorer mental health globally. IMPLICATIONS OF KEY FINDINGS Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits. TRIAL REGISTRATION PROSPERO registration number: CRD42022322528.
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Affiliation(s)
- Joan J Kimutai
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Wilkister N Moturi
- Department of Environmental Science, Faculty of Environment and Resource Development, Egerton University, Njoro, Kenya
| | - Seble Shewangizaw
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Merga Feyasa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Humphrey JM, Alera M, Enane LA, Kipchumba B, Goodrich S, Scanlon M, Songok J, Musick B, Diero L, Yiannoutsos C, Wools-Kaloustian K. Effects of the COVID-19 pandemic on late postpartum women living with HIV in Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001513. [PMID: 36989321 PMCID: PMC10058168 DOI: 10.1371/journal.pgph.0001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
Although an estimated 1.4 million women living with HIV (WHIV) are pregnant each year globally, data describing the effects of the COVID-19 pandemic on postpartum women in low- and middle-income countries (LMICs) are limited. To address this gap, we conducted phone surveys among 170 WHIV ≥18 years and 18-24 months postpartum enrolled in HIV care at the Academic Model Providing Access to Healthcare in western Kenya, and assessed the effects of the pandemic across health, social and economic domains. We found that 47% of WHIV experienced income loss and 71% experienced food insecurity during the pandemic. The majority (96%) of women reported having adequate access to antiretroviral treatment and only 3% reported difficulties refilling medications, suggesting that the program's strategies to maintain HIV service delivery during the early phase of the pandemic were effective. However, 21% of WHIV screened positive for depression and 8% for anxiety disorder, indicating the need for interventions to address the mental health needs of this population. Given the scale and duration of the pandemic, HIV programs in LMICs should work with governments and non-governmental organizations to provide targeted support to WHIV at highest risk of food and income insecurity and their associated adverse health outcomes.
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Affiliation(s)
- John M. Humphrey
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marsha Alera
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Bett Kipchumba
- Department of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, United States of America
| | - Julia Songok
- Department of Paediatrics, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, United States of America
| | - Lameck Diero
- Department of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Constantin Yiannoutsos
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, United States of America
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Charles I, Salinger A, Sweeney R, Batagol B, Barker SF, Nasir S, Taruc RR, Francis N, Clasen T, Sinharoy SS. Joint Food and Water Insecurity Had a Multiplicative Effect on Women's Depression in Urban Informal Settlements in Makassar, Indonesia during the COVID-19 Pandemic. J Nutr 2023; 153:1244-1252. [PMID: 36959077 PMCID: PMC10028453 DOI: 10.1016/j.tjnut.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Women living in urban informal settlements may be particularly vulnerable to the detrimental effects of the COVID-19 pandemic because of increased economic and psychosocial stressors in resource-limited environments. OBJECTIVES The objective of this study was to assess the associations between food and water insecurity during the pandemic and depression among women living in the urban informal settlements in Makassar, Indonesia. METHODS We implemented surveys at 3 time points among women enrolled in the Revitalizing Informal Settlements and their Environments trial. Depression was measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) between November and December 2019 and again between February and March 2021. Food insecurity was measured using questions from the Innovation for Poverty Action's Research for Effective COVID-19 Reponses survey and water insecurity was measured using the Household Water Insecurity Experiences Short Form. Both were measured between August and September 2020. We built 3 multivariate quantile linear regression models to assess the effects of water insecurity, food insecurity, and joint food and water insecurity during the COVID-19 pandemic on CESD-10 score. RESULTS In models with the full sample (n = 323), food insecurity (β: 1.48; 95% CI: 0.79, 2.17), water insecurity (β: 0.13; 95% CI: -0.01, 0.26), and joint food and water insecurity (β: 2.40; 95% CI: 1.43, 3.38) were positively associated with CESD-10 score. In subgroup analyses of respondents for whom we had prepandemic CESD-10 scores (n = 221), joint food and water insecurity (β: 1.96; 95% CI: 0.78, 3.15) maintained the strongest relationship with CESD-10 score. A limitation of this study is that inconsistency in respondents from households across the survey waves reduced the sample size used for this study. CONCLUSIONS Our results find a larger association between depression and joint resource insecurity than with water or food insecurity alone, underlining the importance of addressing food and water insecurity together, particularly as they relate to women's mental health and well-being.
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Affiliation(s)
- Isabel Charles
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA.
| | - Allison Salinger
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA
| | - Rohan Sweeney
- Center for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Becky Batagol
- Monash Sustainable Development Institute and Faculty of Law, Monash University, Melbourne, Australia
| | - S Fiona Barker
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sudirman Nasir
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Universitas Hasanuddin, Centre of Excellence for Interdisciplinary and Sustainability Sciences, Makassar, Indonesia
| | - Ruzka R Taruc
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Naomi Francis
- Monash Sustainable Development Institute and Faculty of Law, Monash University, Melbourne, Australia
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA
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10
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Frongillo EA. Intersection of Food Insecurity and Water Insecurity. J Nutr 2023; 153:922-923. [PMID: 36848987 PMCID: PMC10101199 DOI: 10.1016/j.tjnut.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States.
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Young SL, Bethancourt HJ, Frongillo EA, Viviani S, Cafiero C. Concurrence of water and food insecurities, 25 low- and middle-income countries. Bull World Health Organ 2023; 101:90-101. [PMID: 36733622 PMCID: PMC9874369 DOI: 10.2471/blt.22.288771] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023] Open
Abstract
Objective To investigate how water and food insecurity were associated in nationally representative samples of individuals from 25 low- and middle-income countries. Methods We used data from the 2020 World Gallup Poll in which the Individual Water Insecurity Experiences Scale and the Food Insecurity Experience Scale had been administered to 31 755 respondents. These scales measure insecurity experiences in the previous 12 months. We classified individuals as water insecure if their score was ≥ 12 and food insecure if the Rasch probability parameter was ≥ 0.5. For estimating the proportions, we used projection weights. We estimated the relationships between binary and continuous measures of water insecurity and food insecurity for individuals within each country and region using multivariable logistic and linear regression models, adjusting for key socioeconomic characteristics including income, gender, age and education. Findings Among the 18.3% of respondents who experienced water insecurity, 66.8% also experienced food insecurity. The likelihood of experiencing moderate-to-severe food insecurity was higher among respondents also experiencing water insecurity (adjusted odds ratio, aOR: 2.69; 95% confidence interval, CI: 2.43 to 2.98). Similar odds were found in Asia (aOR: 2.95; 95% CI: 2.04 to 4.25), Latin America (aOR: 2.17; 95% CI: 1.62 to 2.89), North Africa (aOR: 2.92; 95% CI: 2.17 to 3.93) and sub-Saharan Africa (aOR: 2.71; 95% CI: 2.40 to 3.06). Conclusion Our results suggest that water insecurity should be considered when developing food and nutrition policies and interventions. However, more research is needed to understand the paths between these insecurities.
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Affiliation(s)
- Sera L Young
- Department of Anthropology, Northwestern University, 1819 Hinman Avenue, Evanston, Illinois, 60201United States of America (USA)
| | - Hilary J Bethancourt
- Department of Anthropology, Northwestern University, 1819 Hinman Avenue, Evanston, Illinois, 60201United States of America (USA)
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, USA
| | - Sara Viviani
- Statistics Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Carlo Cafiero
- Statistics Division, Food and Agriculture Organization of the United Nations, Rome, Italy
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12
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Bethancourt HJ, Swanson ZS, Nzunza R, Young SL, Lomeiku L, Douglass MJ, Braun DR, Ndiema EK, Pontzer H, Rosinger AY. The co-occurrence of water insecurity and food insecurity among Daasanach pastoralists in northern Kenya. Public Health Nutr 2022; 26:1-11. [PMID: 35941080 PMCID: PMC9989708 DOI: 10.1017/s1368980022001689] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/23/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. DESIGN We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0-36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0-27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. SETTING Northern Kenya, June-July 2019. PARTICIPANTS Daasanach pastoralist households (n 136) from seven communities. RESULTS In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. CONCLUSIONS These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access.
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Affiliation(s)
- Hilary J Bethancourt
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Research Policy, Northwestern University, Evanston, IL, USA
| | - Zane S Swanson
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Research Policy, Northwestern University, Evanston, IL, USA
| | - Luke Lomeiku
- Department of Education and Outreach Programs, National Museums of Kenya, Nairobi, Kenya
| | - Matthew J Douglass
- College of Agricultural Sciences and Natural Resources and Agricultural Research Division, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - David R Braun
- Center for the Advanced Study of Human Paleobiology, Department of Anthropology, The George Washington University, Washington, DC, USA
- Department of Human Evolution, Max Planck Institute of Evolutionary Anthropology, Leipzig, Germany
| | - Emmanuel K Ndiema
- Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
- Global Health Institute, Duke University, Durham, NC, USA
| | - Asher Yoel Rosinger
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA16802, USA
- Department of Anthropology, The Pennsylvania State University, University Park, PA, USA
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13
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Vuong TN, Dang CV, Toze S, Jagals P, Gallegos D, Gatton ML. Household water and food insecurity negatively impacts self-reported physical and mental health in the Vietnamese Mekong Delta. PLoS One 2022; 17:e0267344. [PMID: 35511953 PMCID: PMC9071150 DOI: 10.1371/journal.pone.0267344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/06/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Household food insecurity and inadequate water, sanitation, and hygiene (WASH) contribute to ill health. However, the interactions between household food insecurity, WASH and health have been rarely assessed concurrently. This study investigated compounded impacts of household food insecurity and WASH on self-reported physical and mental health of adults in the Vietnamese Mekong Delta. Materials and methods This cross-sectional survey interviewed 552 households in one northern and one southern province of the Vietnamese Mekong Delta. The survey incorporated previously validated tools such as the Short Form 12-item Health Survey, Household Food Insecurity Assessment Scale, and the Access and Behavioural Outcome Indicators for Water, Sanitation, and Hygiene. Physical and mental health were quantified using the physical health composite score (PCS) and mental health composite score (MCS), respectively. These measures were the dependent variables of interest for this study. Results Statistical analysis revealed that household food insecurity and using <50 litres of water per person per day (pppd) were independently associated with lower PCS (p<0.05), after adjusting for socio-economic confounders. Household food insecurity and lack of food availability, using <50 litres of water pppd, and the use of untreated drinking water were associated with lower MCS (p<0.05), with water usage being an effect modifier of the relationship between household food insecurity and MCS. The results indicate that being food insecure and having limited potable quality water had a compounding effect on MCS, compared to being individually either food insecure or having limited water. Conclusion This study is one of only a few that have established a link between potable water availability, food insecurity and poorer physical and mental health. The results also indicate a need to validate national data with fine-scale investigations in less populous regions to evaluate national initiatives with local populations that may be at higher risk. Adopting joint dual-action policies for interventions that simultaneously address water and food insecurity should result in larger improvements in health, particularly mental health, compared to targeting either food or water insecurity in isolation.
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Affiliation(s)
- Thuy Ngoc Vuong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Public Health in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Chinh Van Dang
- Institute of Public Health in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Simon Toze
- Urban Water Futures, Brisbane, QLD, Australia
| | - Paul Jagals
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- * E-mail:
| | - Michelle L. Gatton
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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14
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Nagata JM, Miller JD, Cohen CR, Frongillo EA, Weke E, Burger R, Wekesa P, Sheira LA, Mocello AR, Otieno P, Butler LM, Bukusi EA, Weiser SD, Young SL. Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya. AIDS Behav 2022; 26:549-555. [PMID: 34373987 PMCID: PMC8813828 DOI: 10.1007/s10461-021-03410-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 12/21/2022]
Abstract
Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, Box 0110, San Francisco, CA, 94158, USA.
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
| | - Joshua D Miller
- Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lila A Sheira
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Phelgona Otieno
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa M Butler
- Institute for Collaboration On Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
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15
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Miller JD, Workman CL, Panchang SV, Sneegas G, Adams EA, Young SL, Thompson AL. Water Security and Nutrition: Current Knowledge and Research Opportunities. Adv Nutr 2021; 12:2525-2539. [PMID: 34265039 PMCID: PMC8634318 DOI: 10.1093/advances/nmab075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Water is an essential nutrient that has primarily been considered in terms of its physiological necessity. But reliable access to water in sufficient quantities and quality is also critical for many nutrition-related behaviors and activities, including growing and cooking diverse foods. Given growing challenges to water availability and safety, including climate change, pollution, and infrastructure degradation, a broader conceptualization of water and its diverse uses is needed to sustainably achieve global nutrition targets. Therefore, we review empirical and qualitative evidence describing the linkages between water security (the reliable availability, accessibility, and quality of water for all household uses) and nutrition. Primary linkages include water security for drinking, food production and preparation, infant and young child feeding, and limiting exposure to pathogens and environmental toxins. We then identify knowledge gaps within each linkage and propose a research agenda for studying water security and nutrition going forward, including the concurrent quantification of both food and water availability, accessibility, use, and stability. By making explicit the connections between water security and nutritional well-being, we aim to promote greater collaboration between the nutrition and water, sanitation, and hygiene sectors. Interdisciplinary policies and programs that holistically address the water-nutrition nexus, versus those that focus on water and nutrition independently, are likely to significantly advance our ability to ensure equitable access to healthy foods and safe water for all.
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Affiliation(s)
- Joshua D Miller
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Sarita V Panchang
- Social Research and Evaluation Center, Louisiana State University, Baton Rouge, LA, USA
| | - Gretchen Sneegas
- Department of Geography, Texas A&M University, College Station, TX, USA
| | - Ellis A Adams
- Keough School of Global Affairs, University of Notre Dame, Notre Dame, IN, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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