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Cai J, Parker M, Tekwe C, Bidulescu A. Food insecurity and mental health among US adults during the COVID-19 pandemic: Results from National Health Interview Survey, 2020-2021. J Affect Disord 2024; 356:707-714. [PMID: 38608771 DOI: 10.1016/j.jad.2024.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To examine socio-demographic disparities in food insecurity during the COVID-19 pandemic and the association between food insecurity and mental health among US adults overall and communities vulnerable to food insecurity. METHODS A cross-sectional study was conducted using the 2020-2021 National Health Interview Survey of 57,456 US adults. Weighted multivariable logistic regression models were used to estimate the association between food insecurity and anxiety or depression symptoms in overall US adults and subgroups including young adults (18-34 years), females, Hispanic people, non-Hispanic Black people, individuals with prior COVID-19 infection, the unemployed, low-income participants, participants with children, and Supplemental Nutrition Assistance Program (SNAP) participants. RESULTS Young or middle age, female sex, Hispanic/non-Hispanic Black/other race/ethnicity, lower education level, unmarried/other marital status, unemployment, being below the federal poverty level, and greater number of persons in the household were associated with food insecurity (AOR ranged from 1.35 to 2.70, all p < 0.05). Food insecurity was independently associated with anxiety (AOR = 2.67, 99 % CI: 2.33, 3.06) or depression (AOR = 3.04, 99 % CI: 2.60, 3.55) symptoms in the overall adults. Significant associations between food insecurity and anxiety or depression symptoms were also observed in all subgroups (AOR ranged from 1.95 to 3.28, all p < 0.0001). Compared with overall adults, the magnitude of the association was greater for participants with children, females (for depression only), and non-Hispanic Black people (for depression only). LIMITATIONS The cross-sectional design prevents inference of causality. CONCLUSIONS Comprehensive policies are needed to ensure accessible and affordable food resources to reduce disparities in food insecurity and improve mental health, especially for those socioeconomically disadvantaged communities.
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Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America.
| | - Maria Parker
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America
| | - Carmen Tekwe
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America
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Beymer MR, Rabbitt MP. The Association Between Food Insecurity and Intimate Partner Violence Among U.S. Army Soldiers. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241253024. [PMID: 38804534 DOI: 10.1177/08862605241253024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Food insecurity in the military ranges between 25% and 33%, significantly higher than the 10.5% for civilians reported by the U.S. Department of Agriculture. The primary objective of this study is to analyze the association between food insecurity and intimate partner violence (IPV) victimization among U.S. Army Soldiers. The secondary objective is to determine if there are any moderating effects in the relationship between food insecurity and IPV victimization by demographic, financial, and mental health covariates. A cross-sectional, online survey was administered by the U.S. Army Public Health Center at an Army installation in 2019; 56% of respondents reported that they were married or in a relationship (n = 2,740). The main predictor was the two-item food insecurity screener (Hunger Vital Signs), which measures marginal food insecurity (encompassing marginal, low, and very low food security). The main outcome was IPV victimization as measured by the Hurt, Insult, Threaten, Scream scale. Multiple logistic regression was used to assess the association between marginal food insecurity and IPV victimization, controlling for demographic, financial, and mental health covariates. In a multivariable model, marginally food insecure respondents had 2.05-fold greater adjusted odds of reporting any IPV victimization when compared to highly food secure respondents (95% confidence interval [1.40, 3.00]). The only interaction that was statistically significant was between anxiety and food insecurity on IPV victimization (p = .0034). Interactions by soldier's military rank, birth sex, and race and ethnicity were not statistically significant. IPV has implications for the emotional and physical health of survivors. In addition, service members who are food insecure may experience similar decrements in emotional and physical health due to suboptimal nutrient intake. By addressing both food insecurity and IPV, the military has the potential to increase the overall well-being of its service members and their dependents.
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Affiliation(s)
- Matthew R Beymer
- Defense Centers for Public Health-Aberdeen (formerly U.S. Army Public Health Center), Behavioral and Social Health Outcomes Practice, Aberdeen Proving Ground, MD, USA
| | - Matthew P Rabbitt
- U.S. Department of Agriculture, Economic Research Service, Kansas City, MO, USA
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Wright V, Hirschfeld W, Walker E, Klein E, White K, Bunin J. Implementation of a "Health Equity Rounds" Curriculum in a Military Internal Medicine Residency Program: A Pilot Study. Mil Med 2024:usae236. [PMID: 38771109 DOI: 10.1093/milmed/usae236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Health disparities in the Military Health System (MHS) have been consistently documented despite the system ensuring equal access to care for its beneficiaries. Research has shown that social, economic, and political factors (i.e., Social Determinants of Health) and health care-specific factors like provider bias and systemic discrimination are key drivers of health disparities in the general population. Medical education focused on introducing these concepts using case-based learning has led to effective learning of health equity terminology. However, a significant gap exists in identifying optimal teaching approaches to develop skills to recognize these factors in actual clinical cases. This begs the million-dollar question: can case-based learning help trainees acquire the skills needed to identify the main factors contributing to health disparities in the MHS? MATERIALS AND METHODS A longitudinal case-based curriculum was developed in which clinical cases from the Internal Medicine Wards, Medical Intensive Care Unit, or General Internal Medicine Clinic at the National Capital Consortium were solicited from trainees and analyzed for evidence of health care provider bias and systemic forms of discrimination using small groups. The National Capital Consortium Internal Medicine Residency Program implemented this pilot study in November 2021. A retrospective pretest-posttest survey assessing trainee reactions to the curriculum and changes in self-reported confidence in skills was used for curriculum assessment. Survey data were analyzed using a paired samples t-test. RESULTS The survey was administered during the last session of the 2022-2023 academic year, with 14 of the 23 available trainees completing it: a 60.8% response rate. Overall, 93% reported that the cases selected that academic year were engaging; the skills they were taught were practice-changing, and the educational value of the curriculum was good, very good, or excellent. Confidence ratings, assessed via a 5-point Likert Scale, demonstrated a statistically significant increase in self-reported confidence in the following skill domains with large effect sizes: identification of bias and systemic discrimination in clinical cases-change in mean: 1.07 (Pre: 3.29, Post: 4.36), P < .001, g = 1.38; recognizing and mitigating personal biases-change in mean: 0.71 (Pre: 3.50, Post: 4.21), P <.001, g = 1.10; participating in a discussion about health care provider bias and systemic discrimination-change in mean: 0.79 (Pre: 3.57, Post: 4.36), P = .001, g = 1.06; and leading a discussion about bias and systemic discrimination-change in mean: 1.00 (Pre: 2.93, Post: 3.93), P = .002, g = 0.98. CONCLUSIONS As the need to address health disparities in the United States becomes more pressing, so does the need for military physicians to recognize the drivers of these disparities within the MHS. Results from this pilot study of Health Equity Rounds suggest that case-based learning may be an optimal teaching approach to improve the skills of military Internal Medicine trainees in identifying and recognizing the impact of health care provider bias and systemic discrimination on clinical cases from the MHS.
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Affiliation(s)
- Veronica Wright
- Combined Internal Medicine/Psychiatry Residency Program, National Capital Consortium, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - William Hirschfeld
- Internal Medicine Residency Program, National Capital Consortium, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Erika Walker
- Internal Medicine Residency Program, National Capital Consortium, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Ezra Klein
- Neurology Residency Program, National Capital Consortium, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Kevin White
- Marine Corps Base Camp Lejeune, Camp Lejeune, NC 28542, USA
| | - Jessica Bunin
- Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
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Elbogen EB, Graziano RC, LaRue G, Cohen AJ, Hooshyar D, Wagner HR, Tsai J. Food Insecurity and Suicidal Ideation: Results from a National Longitudinal Study of Military Veterans. Arch Suicide Res 2024; 28:644-659. [PMID: 37165670 PMCID: PMC10636240 DOI: 10.1080/13811118.2023.2200795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Research examining social determinants of suicide risk in veterans suggests a potential link between food insecurity and subsequent suicidal ideation in military veterans. The objective of this study is to investigate, if and how, food insecurity predicts subsequent suicidal ideation in a nationally representative longitudinal survey of veterans. METHODS A national longitudinal survey was analyzed of participants randomly drawn from over one million U.S. military service members who served after September 11, 2001. N = 1,090 veterans provided two waves of data one year apart (79% retention rate); the final sample was representative of post-9/11 veterans in all 50 states and all military branches. RESULTS Veterans with food insecurity had nearly four times higher suicidal ideation one year later compared to veterans not reporting food insecurity (39% vs 10%). In multivariable analyses controlling for demographic, military, and clinical covariates, food insecurity (OR = 2.37, p =.0165) predicted suicidal ideation one year later, as did mental health disorders (OR = 2.12, p = .0097). Veterans with both food insecurity and mental health disorders had a more than nine-fold increase in predicted probability of suicidal ideation in the subsequent year compared to veterans with neither food insecurity nor mental health disorders (48.5% vs. 5.5%). CONCLUSION These findings identify food insecurity as an independent risk marker for suicidal ideation in military veterans in addition to mental disorders. Food insecurity is both an indicator of and an intervention point for subsequent suicide risk. Regularly assessing for food insecurity, and intervening accordingly, can provide upstream opportunities to reduce odds of suicide among veterans.
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Quartana PJ, Beymer MR, Gomez SAQ, Adler AB, Santo TJ, Thomas JL, Bell AM. COVID-19 Concerns, Information Needs, and Adverse Mental Health Outcomes among U.S. Soldiers. Mil Med 2024; 189:e878-e887. [PMID: 37715687 DOI: 10.1093/milmed/usad350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/31/2023] [Accepted: 08/24/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic disrupted U.S. Military operations and potentially compounded the risk for adverse mental health outcomes by layering unique occupational stress on top of general restrictions, fears, and concerns. The objective of the current study was to characterize the prevalence of COVID-19 concerns and information needs, demographic disparities in these outcomes, and the degree to which COVID-19 concerns and information needs were associated with heightened risk for adverse mental health outcomes among U.S. Army soldiers. MATERIALS AND METHODS Command-directed anonymous surveys were administered electronically to U.S. soldiers assigned to one of three regional commands in the Northwest United States, Europe, and Asia-Pacific Region. Surveys were administered in May to June 2020 to complete (time 1: n = 21,294) and again in December 2020 to January 2021 (time 2: n = 10,861). Only active duty or active reservists/national guard were eligible to participate. Members from other branches of service were also not eligible. RESULTS Highly prevalent COVID-19 concerns included the inability to spend time with friends/family, social activities, and changing rules, regulations, and guidance related to COVID-19. Some information needs were endorsed by one quarter or more soldiers at both time points, including stress management/coping, travel, how to protect oneself, and maintaining mission readiness. COVID-19 concerns and information needs were most prevalent among non-White soldiers. Concerns and information needs did not decline overall between the assessments. Finally, COVID-19 concerns were associated with greater risk of multiple adverse mental health outcomes at both time points. CONCLUSIONS COVID-19 concerns and information needs were prevalent and showed little evidence of decrement over the course of the first 6 months of the pandemic. COVID-19 concerns were consistently associated with adverse mental health outcomes. These data highlight two targets and potential demographic subgroups such that local leadership and Army medicine and public health enterprises can be better prepared to monitor and address to maintain force health and readiness in the face of possible future biomedical threats.
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Affiliation(s)
| | - Matthew R Beymer
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | | | | | - Amy Millikan Bell
- U.S. Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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Tetteh J, Ekem-Ferguson G, Quarshie ENB, Dwomoh D, Swaray SM, Otchi E, Adomako I, Quansah H, Yawson AE. Food insecurity and its impact on substance use and suicidal behaviours among school-going adolescents in Africa: evidence from the Global School-Based Student Health Survey. Eur Child Adolesc Psychiatry 2024; 33:467-480. [PMID: 36859592 DOI: 10.1007/s00787-023-02168-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
The study sought to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its impact on substance use and suicidal behaviours (ideation, planning, and repeated attempted suicide) among school-going adolescents in Africa. The study involved a secondary analysis of cross-sectional data from the Global School-Based Student Health Survey (GSHS) conducted in Africa. Substance use and suicidal behaviours were the main outcomes. We employed the Double Selection Least Absolute Shrinkage and Selection Operator Poisson regression (DSLASSOPM) model to assess risk factors associated with FI and further employed Coarsened Exact Matching involving DSLASSOPM to assess the influence of FI on the study outcomes. Meta-analysis was conducted to obtain between-country heterogeneity in the prevalence of FI and the prevalence ratio of substance use and suicidal behaviours. The study involved 34,912 school-going adolescents. The pooled 30-day prevalence estimate of FI was 11.1% (95% CI 9.1-18.6), ranging from 6.7% (95% CI 5.0-8.3) in Tanzania to 18.4% (95% CI 14.4-22.4) in Benin. The most common associated factors included the experience of insomnia and the number of times injured. The pooled prevalence ratio of substance use, suicidal ideation, suicidal planning, and repeated attempted suicide among adolescents experiencing food insecurity were 1.92(95% CI 1.69-2.16), 1.56(95% CI 1.46-1.66), 1.50 (95% CI 1.41-1.58), and 1.90 (95% CI 1.73-2.07) respectively. A considerable heterogeneity between the sub-regions prevalence ratio for suicidal ideation and planning was also observed (I2 = 0, p value > 0.05). The study observed a high prevalence of food insecurity in West Africa with negligible heterogeneity between the countries. A significant positive association between FI and the study outcomes (substance use and suicidal behaviours) was observed. The study recommends country-specific social and school-based health interventions to screen risk factors associated with food insecurity for early identification. Measures to achieve Sustainable Development Goal 2 (Zero Hunger) by 2030 are key in these African countries and is likely to yield demographic dividends through improvement in mental health among school-going adolescents.
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Affiliation(s)
- John Tetteh
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
| | | | - Emmanuel Nii-Boye Quarshie
- Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, Accra, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Elom Otchi
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Korle-Bu Teaching Hospital, Accra, Ghana
| | - Isaac Adomako
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Henry Quansah
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Kearns JC, Edwards ER, Finley EP, Geraci JC, Gildea SM, Goodman M, Hwang I, Kennedy CJ, King AJ, Luedtke A, Marx BP, Petukhova MV, Sampson NA, Seim RW, Stanley IH, Stein MB, Ursano RJ, Kessler RC. A practical risk calculator for suicidal behavior among transitioning U.S. Army soldiers: results from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS). Psychol Med 2023; 53:7096-7105. [PMID: 37815485 PMCID: PMC10575670 DOI: 10.1017/s0033291723000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Risk of suicide-related behaviors is elevated among military personnel transitioning to civilian life. An earlier report showed that high-risk U.S. Army soldiers could be identified shortly before this transition with a machine learning model that included predictors from administrative systems, self-report surveys, and geospatial data. Based on this result, a Veterans Affairs and Army initiative was launched to evaluate a suicide-prevention intervention for high-risk transitioning soldiers. To make targeting practical, though, a streamlined model and risk calculator were needed that used only a short series of self-report survey questions. METHODS We revised the original model in a sample of n = 8335 observations from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS) who participated in one of three Army STARRS 2011-2014 baseline surveys while in service and in one or more subsequent panel surveys (LS1: 2016-2018, LS2: 2018-2019) after leaving service. We trained ensemble machine learning models with constrained numbers of item-level survey predictors in a 70% training sample. The outcome was self-reported post-transition suicide attempts (SA). The models were validated in the 30% test sample. RESULTS Twelve-month post-transition SA prevalence was 1.0% (s.e. = 0.1). The best constrained model, with only 17 predictors, had a test sample ROC-AUC of 0.85 (s.e. = 0.03). The 10-30% of respondents with the highest predicted risk included 44.9-92.5% of 12-month SAs. CONCLUSIONS An accurate SA risk calculator based on a short self-report survey can target transitioning soldiers shortly before leaving service for intervention to prevent post-transition SA.
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Affiliation(s)
- Jaclyn C. Kearns
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Emily R. Edwards
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin P. Finley
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA
- Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Joseph C. Geraci
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA
- Resilience Center for Veterans & Families, Teachers College, Columbia University, New York, NY, USA
| | - Sarah M. Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Marianne Goodman
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Chris J. Kennedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew J. King
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Richard W. Seim
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX, USA
| | - Ian H. Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO USA
- Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- School of Public Health, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, La Jolla, CA, USA
| | - Robert J. Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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O’Neal CW, Lucier-Greer M, Lewis C, Farnsworth M. Use of food distribution resources among military families with young children since the COVID-19 pandemic. Public Health Nutr 2023; 26:1968-1975. [PMID: 37565497 PMCID: PMC10564604 DOI: 10.1017/s1368980023001738] [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: 12/18/2022] [Revised: 06/03/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The present study examined military families' use of food distribution resources and military (e.g. rank) and non-military (e.g. race/ethnicity) characteristics associated with using food distribution resources. DESIGN Secondary data analyses from a cross-sectional survey in the first 6 months of 2021. SETTING A national sample of eligible families completed an online survey. PARTICIPANTS 8326 enlisted military families with an active duty service member in the United States Army or Air Force who applied for supplemental childcare funding distributed by National Military Family Association. RESULTS 13·2 % of the families reported utilising a food distribution resource in the past 12 months. Those with lower financial well-being were more likely to utilise such resources. Older (OR = 1·04, 95 % CI = 1·02, 1·05, P < 0·001), single-earner (OR = 0·73, 95 % CI = 0·61, 0·89, P = 0·001) families with a lower rank (OR = 0·69, 95 % CI = 0·64, 0·75, P < 0·001) and Army affiliation (compared with Air Force) (OR = 2·31, 95 % CI = 2·01, 2·67, P < 0·001) were more likely to utilise food distribution resources. Members of certain racial/ethnic minority groups were more likely to utilise food distribution resources than White respondents (OR from 1·47 for multi-racial to 1·69 for Asians), as were families with more dependent children (OR = 1·35, 95 % CI = 1·25, 1·47, P < 0·001). CONCLUSIONS These results identify the extent of food distribution resource utilisation in military families with young children approximately 1 year into the COVID-19 pandemic. The results also identify characteristics associated with their use of food distribution resources. Findings are discussed with an emphasis on prevention and intervention implications for military families.
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Affiliation(s)
- Catherine W O’Neal
- Department of Human Development and Family Science, 202 Family Science Center II, University of Georgia, Athens, GA30602, USA
| | - Mallory Lucier-Greer
- Department of Human Development and Family Science, 203 Spidle Hall, Auburn University, Auburn, AL36849, USA
| | | | - Meredith Farnsworth
- National Military Family Association, 2800 Eisenhower Avenue, Suite 250, Alexandria, VA22314, USA
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Bruening M, Laska MN. Position of the Society for Nutrition Education and Behavior: Food and Nutrition Insecurity Among College Students. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:699-709. [PMID: 37656095 DOI: 10.1016/j.jneb.2023.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Meg Bruening
- Department of Nutritional Sciences, The College of Health and Human Development, The Pennsylvania State University, University Park, PA.
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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Giombi KC, Rabbitt MP, Karns S. Military Eligibility for the Supplemental Nutrition Assistance Program: Simulating the Exemption of the Basic Allowance for Housing from Gross Income. J Nutr 2023; 153:2726-2735. [PMID: 37394118 DOI: 10.1016/j.tjnut.2023.06.038] [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: 03/23/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Twenty-four percent of active-duty service member households experienced food insecurity in 2020; however, limited data have suggested that few participate in the Supplemental Nutrition Assistance Program (SNAP). A potential reason for low SNAP participation among active-duty military households is that the basic allowance for housing (BAH) is considered countable income for SNAP eligibility determination. OBJECTIVES This study explores how many more service members' households, referred to as "SNAP units" (that is, a group of individuals who live together and regularly buy food and prepare meals together), would become eligible for SNAP benefits if the BAH is excluded from countable income in deciding eligibility. METHODS This study used 2016-2020 American Community Survey 5-y estimates to construct a sample of active-duty military households combined with data on military pay and allowances to simulate changes to SNAP eligibility and poverty status with a BAH exemption as well as impacts on federal spending on SNAP. RESULTS Eligibility for SNAP among military SNAP units increases from 0.4% to 1.5% (263% increase) if a service member's BAH was exempted from their gross income. The increase was driven by SNAP units whose highest-ranking service member was from the noncommissioned officer ranks without dependents. As more military SNAP units became eligible and chose to participate, annual SNAP disbursements (that is, amount of funds spent on SNAP) for the whole program increased by up to 1.3%, compared with FY16-20 SNAP disbursements. With an increase in SNAP participation, the poverty rate among military SNAP units decreases from 8.7% to 1.4% (83.9% decrease). CONCLUSIONS Exempting service members' BAH from their gross income would likely increase SNAP eligibility and participation among military households and, in turn, reduce poverty.
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Affiliation(s)
| | - Matthew P Rabbitt
- United States Department of Agriculture, Economic Research Service, Kansas City, MO, United States
| | - Shawn Karns
- RTI International, Research Triangle Park, NC, United States
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Valladares-Garrido MJ, Zapata-Castro LE, Picón-Reategui CK, Mesta-Pintado AP, Picón-Reategui RA, Huaman-Garcia M, Pereira-Victorio CJ, Valladares-Garrido D, Failoc-Rojas VE. Association between Working Time and Burnout Syndrome in Peruvian Military during the Second Epidemic Wave of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13614. [PMID: 36294208 PMCID: PMC9602622 DOI: 10.3390/ijerph192013614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
There is scant evidence on the impact of the COVID-19 pandemic on burnout in front-line military personnel and how working time may influence on this condition. We aimed to determine the association between working time and Burnout syndrome in military personnel. A cross-sectional study was conducted using secondary data among 576 military personnel from Lambayeque, Peru during the second wave of COVID-19 in 2021. We used the Maslach Burnout Inventory instrument to measure Burnout Syndrome. We evaluated its association with work time, measured as the number of months that the military member worked during the pandemic. The prevalence of burnout syndrome was 9%. Of the total sample, 39.1% and 10.3% presented depersonalization and emotional exhaustion, respectively. Military personnel working for more than 18 months had a 104% higher prevalence of Burnout syndrome (PR: 2.04, 95%CI: 1.02-4.10). Exposure to a prolonged work time during the pandemic increased the prevalence of Burnout syndrome in military personnel. This information helps to understand the potential effects of the pandemic on this population and provides insight into the time the military members would need rest to prevent Burnout syndrome.
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Affiliation(s)
- Mario J. Valladares-Garrido
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo 14012, Peru
| | - Luis Eduardo Zapata-Castro
- Escuela de Medicina, Universidad Nacional de Piura, Piura 20002, Peru
- Scientific Society of Medical Students, Universidad Nacional de Piura, Piura 20002, Peru
| | | | | | | | | | | | - Danai Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Piura 13001, Peru
- Unidad de Epidemiología y Salud Ambiental, Hospital de Apoyo II Santa Rosa, Piura 20008, Peru
| | - Virgilio E. Failoc-Rojas
- Research Unit for Generation and Synthesis Evidence in Health, Universidad San Ignacio de Loyola, Lima 15024, Peru
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12
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Liese AD. Shining a light on marginal food insecurity in an understudied population. Public Health Nutr 2022; 25:1-2. [PMID: 35546059 PMCID: PMC9991656 DOI: 10.1017/s1368980022001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC29208, USA
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13
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Adler AB, Gutierrez IA, Gomez SAQ, Beymer MR, Santo TJ, Thomas JL, Cates DS, Bell AM, Quartana PJ. US soldiers and the role of leadership: COVID-19, mental health, and adherence to public health guidelines. BMC Public Health 2022; 22:943. [PMID: 35546398 PMCID: PMC9092038 DOI: 10.1186/s12889-022-13345-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have documented the impact of domain-specific leadership behaviors on targeted health outcomes in employees. The goal of the present study was to determine the association between specific leadership behaviors addressing COVID-19 and US soldiers’ mental health and adherence to COVID-19 public health guidelines. Methods An electronic, anonymous survey was administered to US Army soldiers across three major commands (N = 7,829) from December 2020 to January 2021. The primary predictor of interest was soldiers’ ratings of their immediate supervisors’ behaviors related to COVID-19. The outcomes were soldiers’ mental health (i.e., depression and generalized anxiety) and adherence to COVID-19 public health guidelines. Covariates were rank, gender, ratings of immediate supervisors’ general leadership, level of COVID-19 concerns, and COVID-19 status (e.g., tested positive, became seriously ill). Logistic regressions were used to model the unique association of COVID-19 leadership behaviors with outcomes after adjusting for covariates. Results High levels of COVID-19 leadership behaviors were associated with lesser likelihood of soldiers’ screening positive for depression (AOR = 0.46; 95% CI [0.39, 0.54]) and anxiety (AOR = 0.54; 95% CI [0.45, 0.64]), and greater likelihood of frequent adherence to preventive health guidelines (AORs = 1.58; 95% CI [1.39, 1.80] to 2.50; 95% CI [2.01, 3.11]). Conclusion Higher levels of COVID-19 leadership behaviors may support soldiers’ mental health and encourage their adherence to COVID-19 public health guidelines. Given the link between these leader behaviors and soldier adaptation to the pandemic over and above general leadership, training for supervisors should focus on targeting specific health-promoting behaviors. Results can inform leader training for the military and other high-risk occupations.
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Affiliation(s)
- Amy B Adler
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA.
| | - Ian A Gutierrez
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | | | - Matthew R Beymer
- US Army Public Health Center, Aberdeen Proving Ground, Aberdeen, MD, USA
| | | | | | - David S Cates
- Nebraska Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amy Millikan Bell
- US Army Public Health Center, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Phillip J Quartana
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
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14
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Rabbitt MP, Beymer MR, Reagan JJ, Jarvis BP, Watkins EY. Food insecurity among active duty soldiers and their families during the coronavirus disease 2019 pandemic. Public Health Nutr 2022; 25:1-8. [PMID: 35067266 PMCID: PMC8861550 DOI: 10.1017/s1368980022000192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/04/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We examined the determinants of food insecurity among active duty Army households that transitioned into food insecurity during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN We compared Army households that recently transitioned into marginal food insecurity with those households that remained highly food secure (n 2832) to better understand how these households differ in their resilience to food insecurity during economic downturns using data from a military installation in the USA in 2020. SETTING A US military installation in the USA. PARTICIPANTS Active duty US Army soldiers. RESULTS Prior to the pandemic, the prevalence of marginal food insecurity among Army households was similar to that reported for households in the general population. Marginal food insecurity among Army households increased over 1·5-fold - from 19 % to 33 % - with the onset of the pandemic. Relative to Army households with consistently high food security, the Army households that transitioned into marginal food insecurity after the onset of the pandemic were more likely to report concerns about financial insecurity and the job security of their family members. CONCLUSIONS Army households, like their civilian counterparts, are vulnerable to food insecurity because of instability in their income during periods of economic uncertainty. Periods of economic uncertainty are more common for Army households because of the frequent relocations associated with military service which could lead to predictable periodic spikes in their food insecurity.
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Affiliation(s)
- Matthew P Rabbitt
- U.S. Department of Agriculture, Economic Research Service, PO Box 419205, MS 9999, Kansas City, MO64141-6205, USA
| | - Matthew R Beymer
- U.S. Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, MD, USA
| | - Joanna J Reagan
- U.S. Army Public Health Center, Health Promotion and Wellness Directorate, Aberdeen Proving Ground, MD, USA
| | - Brantley P Jarvis
- U.S. Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, MD, USA
| | - Eren Y Watkins
- U.S. Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, MD, USA
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15
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The Mental Health Outcomes of Food Insecurity and Insufficiency in West Africa: A Systematic Narrative Review. Behav Sci (Basel) 2021; 11:bs11110146. [PMID: 34821607 PMCID: PMC8614760 DOI: 10.3390/bs11110146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Food insufficiency is a global pandemic affecting many people, especially those residing in developing countries. African countries have been affected by food insufficiency, which is mostly caused by drought or wars. Famine or food insufficiency has been reported to have an impact on the psychological health and quality of life of people affected. This review assessed the mental health outcomes of famine and food insufficiency in West Africa. (2) Methods: A search of the published literature was conducted using PubMed, PsycExtra, Medline, and PsycINFO databases. The search was limited to papers published in English between the years 2010 and 2020. Two reviewers independently screened the titles and abstracts of the retrieved papers using pre-defined inclusion and exclusion criteria and a third reviewer resolved conflicts. Data were extracted and appraised using a data extraction form and an appraisal checklist. (3) Results: A total of 81 papers were identified through the journal databases search. Out of the seven papers that met the inclusion criteria, six papers used cross-sectional designs and one paper used an experimental design. The six papers used quantitative approach for data collection, while the one paper used a qualitative technique. The evidence synthesized from this review indicated that exposure to food insecurity or insufficiency is associated with increased psychological distress including anxiety, sleeplessness, intellectual disability, general mental, and emotional instability. (4) Conclusions: This review strongly highlights the need for further research across the sub-region. It further suggests that famine and food insufficiency are associated with significant mental health problems in adults and impacts the cognitive and intellectual development of children. Although there is paucity of literature about famine and its impact on mental health in West Africa, these findings are important for developing social policy initiatives for increasing food supply and mental health interventions for all ages.
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