Food insecurity is associated with anxiety, stress, and symptoms of posttraumatic stress disorder in a cohort of women with or at risk of HIV in the United States

Are we gatekeeping trauma? A conceptual model to expand criterion A for invisible, identity-based, and systemic traumas

Since the inception of the criterion A framework into the posttraumatic stress disorder (PTSD) diagnosis in DSM-III, what qualifies as traumatic has been a fieldwide debate. Historically, social movements coinciding with advances in research have spurred improvements in the definition of criterion A, often by expanding the breadth of experiences that are considered trauma exposure. Contemporary issues of ongoing racial discrimination, ethno-violence, public health pandemics, warfare, oppression, and climate change warrant a re-examination of the criterion A definition. This critical review builds on prior critiques of criterion A and addresses (1) the limitations to the current criterion A definition in DSM-5 in capturing the experience of minoritized individuals; (2) three categories of trauma that are under-recognized in the current criterion A definition; and (3) the implications of expanding criterion A on clinical and research practice. We critically review three trauma categories that disproportionately affect minoritized individuals-invisible traumas, identity-based traumas, and systemic traumas. Evidence to date suggests that several traumatic experiences in these categories rise to the level of being traumatic, are associated with PTSD symptoms, and are prevalent among minoritized individuals. We discuss the implications of these traumas being omitted from criterion A and call for future work to critically examine the definition of criterion A in the PTSD diagnostic framework. Overall, this critical review captures traumas which remain undertreated, underdiagnosed, and under-represented by our current psychiatric nosology.

Is the Impact of Food Insecurity on Food-Related Behavior Moderated by Generation in South Korea?

The purposes of this study were to determine whether perceived food insecurity significantly influences food purchasing behaviors, food preparation practices, and life satisfaction; and to verify the moderating effect of generation in South Korea. Structural equation modeling and multi-group analyses were conducted to confirm the research model and test the hypotheses. Perceived food insecurity positively influenced food purchasing behaviors and food preparation practices. In addition, this study verified the presence of a significant negative relationship between perceived food insecurity and life satisfaction. Notably, a greater awareness of food insecurity in Generation M increased food preparation practices, and the negative impact of perceived food insecurity on life satisfaction was more strongly exhibited in the older generation than in the younger generation. This presents a need to pay greater attention to food insecurity issues at the government level and accelerate related future research. Specifically, it will be necessary to establish a structured educational environment and support services for systematic food security education. Also, rather than educating people with high levels of perceived food insecurity about why they should eat healthy food, proactive efforts should first be made to remove barriers to healthy eating habits. As a preventive measure against the worsening of food insecurity, more solutions should be prepared from a macroscopic perspective in addition to implications from the microscopic perspective mentioned so far.

Sexual Response Problems and Their Correlates Among Older Adults From the Sexual Well-Being (SWELL) Study in China: Multicenter Cross-Sectional Study

Background

Sexual response problems among older adults are not an inevitable consequence of aging but rather a response to sexual health. However, there is a lack of recent and multicenter data on this issue in China.

Objective

This study aims to assess the prevalence of sexual response problems and their correlates among older adults.

Methods

A multicenter cross-sectional study on sexual well-being was conducted among individuals aged more than 50 years in China between June 2020 and December 2022. Data on sociodemographics, physical health, psychological health, and sexual response problems were collected through face-to-face interviews. We included sexually active older adults who reported either vaginal, oral, or anal sex in the past 12 months for this study. Sexual response problems included a lack of interest or enjoyment in sex; feeling anxious, having pain, or no excitement during sex; no desire or orgasms; and the lack of lubrication in sex. The stepwise logistic regression models were used to examine the correlates of sexual response problems.

Results

A total of 1317 sexually active older adults (842 men, 475 women) were included. Older women reported a higher prevalence of sexual response problems than older men (52.0% [247/475] vs 43.1% [363/842]). Common factors associated with at least one of the sexual response problems included living in rural areas (men: adjusted odds ratio [aOR]=0.31, 95% CI 0.22-0.43; women: aOR=0.29, 95% CI 0.19-0.43) and abnormal BMI (aOR=men: 1.52, 95% CI1.11-2.07; women: aOR=2.19, 95% CI 1.47-3.28). Among older men, sleep quality (aOR=1.87, 95% CI 1.30-2.68), emotional connection with sex partners during sexual intercourse (aOR=0.69, 95% CI 0.50-0.96), frequently experienced fatigue (aOR=2.47, 95% CI 1.59-3.90), anxiety (aOR=4.26, 95% CI 1.12-21.27), and seeking professional help for sex life (aOR=1.58, 95% CI 1.14-2.21) were associated with sexual response problems. Among older women, sexual response problems were associated with a lack of physical exercise (aOR=1.69, 95% CI 1.13-2.54), poor sex-partner relationships (aOR=1.70, 95% CI 1.12-2.60), and depressive symptoms (aOR=3.18, 95% CI 1.18-10.24).

Conclusions

Sexual response problems are common among older adults. These problems were associated with adverse physical health, mental health, and poor sex-partner relationships. These findings highlight the importance for health care providers to take into account the physical and psychological health of older adults, as well as the quality of their relationships with sexual partners when diagnosing and addressing sexual response problems.

Food Is Medicine for Human Immunodeficiency Virus: Improved Health and Hospitalizations in the Changing Health Through Food Support (CHEFS-HIV) Pragmatic Randomized Trial

BACKGROUND

Policy support for "food is medicine"-medically tailored meals or groceries to improve health-is rapidly growing. No randomized trials have heretofore investigated the benefits of medically tailored food programs for people with human immunodeficiency virus (PWH).

METHODS

The CHEFS-HIV pragmatic randomized trial included PWH who were clients of Project Open Hand (POH), a San Francisco-based nonprofit food organization. The intervention arm (n = 93) received comprehensive medically tailored meals, groceries, and nutritional education. Control participants (n = 98) received less intensive (POH "standard of care") food services. Health, nutrition, and behavioral outcomes were assessed at baseline and 6 months later. Primary outcomes measured were viral nonsuppression and health-related quality of life. Mixed models estimated treatment effects as differences-in-differences between arms.

RESULTS

The intervention arm had lower odds of hospitalization (odds ratio [OR], 0.11), food insecurity (OR, 0.23), depressive symptoms (OR, 0.32), antiretroviral therapy adherence <90% (OR, 0.18), and unprotected sex (OR, 0.18), as well as less fatty food consumption (β = -.170 servings/day) over 6 months, compared to the control arm. There was no difference between study arms in viral nonsuppression and health-related quality of life over 6 months.

CONCLUSIONS

A "food is medicine" intervention reduced hospitalizations and improved mental and physical health among PWH, despite no impact on viral suppression.

CLINICAL TRIALS REGISTRATION

NCT03191253.

Trauma exposure, contextual stressors, and PTSD symptoms: patterns in racially and ethnically diverse, low-income postpartum women

BACKGROUND

Racial, ethnic, and socioeconomic disparities persist in posttraumatic stress disorder (PTSD), which are partly attributed to minoritized women being trauma-exposed, while also contending with harmful contextual stressors. However, few have used analytic strategies that capture the interplay of these experiences and their relation to PTSD. The current study used a person-centered statistical approach to examine heterogeneity in trauma and contextual stress exposure, and their associations with PTSD and underlying symptom dimensions, in a diverse sample of low-income postpartum women.

METHODS

Using a community-based sample of Black, Hispanic/Latina, and White postpartum women recruited from five U.S. regions (n = 1577), a latent class analysis generated profiles of past-year exposure to traumatic events and contextual stress at one month postpartum. Regression analyses then examined associations between class membership and PTSD symptom severity at six months postpartum as a function of race/ethnicity.

RESULTS

A four-class solution best fit the data, yielding High Contextual Stress, Injury/Illness, Violence Exposure, and Low Trauma/Contextual Stress classes. Compared to the Low Trauma/Contextual Stress class, membership in any of the other classes was associated with greater symptom severity across nearly all PTSD symptom dimensions (all ps < 0.05). Additionally, constellations of exposures were differentially linked to total PTSD symptom severity, reexperiencing, and numbing PTSD symptoms across racial/ethnic groups (ps < 0.05).

CONCLUSIONS

A person-centered approach to trauma and contextual stress exposure can capture heterogeneity of experiences in diverse, low-income women. Moreover, racially/ethnically patterned links between traumatic or stressful exposures and PTSD symptom dimensions have implications for screening and intervention in the perinatal period.

Low food security is associated with frailty status and frailty components among people with HIV

BACKGROUND

Low food security is common among people with HIV (PWH) and is associated with poorer health outcomes. Frailty, an aging-related outcome that is increasingly prevalent among PWH, may be stimulated by low food security. We assessed associations between food security and frailty among PWH.

METHODS

The Impact of Physical Activity Routines and Dietary Intake on the Longitudinal Symptom Experience of People Living with HIV (PROSPER-HIV) study follows PWH to evaluate how diet and physical activity impact symptoms. We utilized food security and frailty data from PROSPER-HIV Year 1 visits (January 2019 to July 2022) to estimate associations. Food security was measured via the validated two-item Food Security Questionnaire and categorized as Food Secure, Low Food Security, or Very Low Food Security. Frailty was measured with the Fried frailty phenotype, and categorized as robust, prefrail, and frail. We used relative risk regression to estimate associations between food security and frailty status, adjusted for demographic characteristics.

RESULTS

Among 574 PWH, nearly one-quarter were women (22%), mean age was 52 years old, 8% were frail, and 46% prefrail. Low food security was reported among nearly one-third of PWH: 13% Low Food Security and 18% Very Low Food Security. Compared with being Food Secure, we found Low Food Security was associated with frailty [prevalence ratio: 4.06 (95% confidence interval (CI) 2.16-7.62] and Very Low Food Security was associated with both prefrailty [1.48 (1.23-1.78)] and frailty [5.61 (3.14-10.0)], as compared with robust status.

CONCLUSION

Low food security was associated with increased frailty among PWH in this study, suggesting a potential intervention point to promote healthy aging.

Anxiety and sleep mediate the effect of food insecurity on depression in single parents in Ghana

BACKGROUND

Data on the association between food insecurity and depression in single parents in low- and middle-income countries (LMICs) are limited, and no study has reported the serial mediation effects of psychosocial factors in this association. This study examines the extent to which anxiety and sleep serially explain the food insecurity and depression link among single parents in Ghana.

METHODS

Data on 627 single parents were obtained through a multi-stage stratified sampling technique. Food insecurity was assessed using the Food and Agriculture Organization Food Insecurity Experience Scale (FIES), and depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D-10). Multivariable OLS models and bootstrapping serial mediation analyses were performed to evaluate the hypothesized associations.

RESULTS

The mean age (SD) was 45.0 (14.7) years; 67.3% females. After full adjustment, food insecurity was significantly associated with increases in anxiety symptoms (β = 0.61, 95%CI = 0.476 - 0.737), sleep problems (β = 0.04, 95%CI = 0.02 - 0.07), and depression (β = 0.24, 95%CI = 0.12 - 0.36). Food insecurity indirectly related to depression via anxiety (β = 0.35, 95%CI = 0.26-0.44) representing 55.8%, sleep (β = 0.03, 95%CI = 0.0032-0.0575) suggesting 4.0%, and anxiety→sleep (β = 0.013, 95%CI = 0.0024-0.0265) yielding 2.0% of the total effect.

CONCLUSIONS

Food insecurity was positively associated with depression. This association was partially and serially explained by generalized anxiety and sleep problems. Efforts to address depression among single parents should consider interventions for food insecurity and psychosocial problems, particularly in LMICs.

Exploring Food Insecurity and Perceived Stress on Daytime Sleepiness among Older Adults in New York City

The growing population of older adults in the U.S. is experiencing increased food insecurity and stress, which are associated with nocturnal sleep quality and consequently excessive daytime sleepiness. This study aimed to investigate the relationship between food insecurity and perceived stress on daytime sleepiness in older adults aged 60 and older living in New York City. This cross-sectional, quantitative study utilized the US Household Food Security Survey Module six-item questionnaire, the Perceived Stress Scale (PSS), and Sleepiness Total to collect data. Participants completed an online survey via Qualtrics. Linear and logistic regression models were used to assess the association between demographic variables and food insecurity, perceived stress, and daytime sleepiness outcomes. Three hundred seventy-eight (378) older adults participated in this study. Food insecurity was associated with age (p = 0.045), education (p = 0.022), and daytime sleepiness (p < 0.001). On average, participants with a BMI of over 30 had an increased daytime sleepiness total relative to a BMI < 25 (p = 0.029), and those with two to three health conditions and those with more than four health conditions had higher daytime sleepiness totals relative to those with zero to one condition (p = 0.007 and 0.007, respectively). Participants who had moderate and high stress, regardless of food security status, had higher daytime sleepiness totals than those with low stress (food secure; p = 0.002; food insecure; p < 0.001). Multifaceted interventions are needed to alleviate food insecurity, manage stress, and reduce excessive daytime sleepiness among older adults.

Changes in HIV Internalized and Experienced Stigmas and Social Support After an Urban Gardens and Peer Nutritional Counseling Intervention Among People With HIV and Food Insecurity in the Dominican Republic

BACKGROUND

Food insecurity and HIV-related stigma negatively affect HIV outcomes. Few studies have examined how food security interventions affect HIV-related stigma and social support.

SETTING

Two HIV clinics in the Dominican Republic.

METHODS

A pilot cluster randomized controlled trial of an urban gardens and peer nutritional counseling intervention was conducted to examine outcomes of HIV-related stigmas and social support. Adult patients (≥18 years of age) with moderate or severe household food insecurity and evidence of suboptimal ART adherence and/or a detectable viral load were enrolled; standard measures of internalized and experienced stigmas and social support were collected at baseline and at 6 and 12 months. Intervention clinic participants received training and materials from agronomists for a home garden, 3-4 sessions of nutritional counseling from the clinic's peer counselor, and a garden produce cooking workshop facilitated by professional nutritionists.

RESULTS

Of 109 study participants (46 intervention and 63 control), 103 (94%) completed 12-month follow-up. Difference-in-differences multivariate longitudinal linear regressions adjusting for sociodemographic factors found that intervention participants had reduced internalized stigma by 3.04 points (scale 0-32) at 12 months (P = 0.002); reduced probability of experiencing HIV-related stigma or discrimination in the past 6 months (20 percentage points at 6 months, P = 0.05 and 25 percentage points at 12 months, P = 0.02); and modestly improved social support at 12 months (1.85 points on 30-pt scale, P = 0.093).

CONCLUSION

A fully powered, larger trial is needed to establish the efficacy of the intervention and assess pathways by which the intervention may improve HIV stigma and social support.

Longitudinal Associations Between Food Insecurity and Mental Health in Aging Adults in South Africa

OBJECTIVES

The aim of this study was to assess the longitudinal unidirectional and bidirectional associations between food insecurity and mental health among aging adults in South Africa.

METHODS

The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa (HAALSI) study.

RESULTS

The proportion of food insecurity was 20.2% in 2015, 24.1% in 2019 and 18.4% in 2021/2022. Food insecurity was positively associated depressive symptoms, poor life satisfaction, poor sleep quality, PTSD, loneliness, impaired cognition, and current tobacco use. Compared to without food insecurity in all three study waves, having food insecurity in one wave and/or two to three waves was positively associated with incident depressive symptoms, incident poor life satisfaction, incident poor sleep quality, incident PTSD, incident loneliness, incident current tobacco use, and incident current heavy alcohol use. PTSD, impaired cognition, current tobacco use and current heavy alcohol use were positively associated with incident food insecurity.

CONCLUSION

We found that food insecurity was unidirectionally associated with depressive symptoms, poor life satisfaction, poor sleep quality and loneliness, and bidirectionally associated with PTSD, impaired cognition, current tobacco use and current heavy alcohol use.

CLINICAL IMPLICATIONS

Enhanced screening and management of food insecurity may reduce mental ill-health in South Africa.

Pandemic stressors and mental health indicators in eight countries

PURPOSE

The Covid-19 pandemic has exacted a significant physical, financial, social, and emotional toll on populations throughout the world. This study aimed to document the association between pandemic stressors and mental health during the pandemic across countries that differ in cultural, geographic, economic, and demographic factors.

METHODS

We administered an online survey randomly in Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States from September 2020 to November 2020. This survey included questions on Covid-19-related stressors as well as the Patient Health Questionnaire-2 and the Primary Care PTSD Checklist to screen for depression and post-traumatic stress disorder (PTSD) symptoms, respectively. We performed bivariable and multivariable regression analyses to assess the prevalence and odds ratios of overall depression symptoms and probable PTSD and in relation to stressors across countries.

RESULTS

Among 8754 respondents, 28.9% (95% CI 27.5-30.0%) experienced depression symptoms, and 5.1% (95% CI 4.5-6.0%) experienced probable PTSD. The highest prevalence of depression symptoms was in Egypt (41.3%, 95% CI 37.6-45.0%) and lowest in the United States (24.9%, 95% CI 22.3-27.7%). The highest prevalence of probable PTSD was in Brazil (7.3%, 95% CI 5.6-9.4%) and the lowest in China (1.2%, 95% CI 0.7-2.0%). Overall, experiencing six or more Covid-19-related stressors was associated with both depression symptoms (OR 1.90, 95% CI 1.46-2.48) and probable PTSD (OR 13.8, 95% CI 9.66-19.6).

CONCLUSION

The association between pandemic related stressors and the burden of adverse mental health indicators early in the Covid-19 pandemic transcended geographic, economic, cultural, and demographic differences between countries. The short-term and long-term impacts of the pandemic on mental health should be incorporated in efforts to tackle the consequences of Covid-19.

"I'm Doing the Best that I Can": Mothers Lived Experience with Food Insecurity, Coping Strategies, and Mental Health Implications

Background

Food insecurity can have lasting physical and mental health consequences. The experience of food insecurity within a household may disproportionately impact mothers because they tend to manage the household food environment.

Objective

This study sought to understand the stresses faced by United States mothers experiencing food insecurity, related coping mechanisms, and the impacts of these stressors on their mental health.

Methods

Semistructured interviews were conducted in May and June 2022 with a purposive sample of Virginia mothers who reported experiences of food insecurity. Participants were recruited from a related survey and university and community LISTSERVs. Interviews were transcribed and analyzed by trained coders. A thematic analysis was conducted to describe themes that emerged from the data. Virtual interviews were 20-60 min in duration. Mothers with children living in their household, having experienced food insecurity, and living in Virginia were eligible.

Results

The following 3 themes emerged from the interviews with the mothers (n = 15): 1) food insecurity added stress to mothers' lives in multiple ways (e.g. worry about obtaining the "right" foods and internalized or experienced stigma), 2) mothers used positive and negative coping strategies to address the impacts of these stressors (e.g. use of community resources and reduced personal food intake), and 3) the stressors and coping strategies had varying impacts on mothers' mental health (e.g. added to existing mental health challenges or reduced their mental capacity to make changes).

Conclusions

Study findings suggest that a multilevel and tailored approach to address diverse stressors is warranted. Future research should explore emotional coping strategies that comprehensively empower mothers to manage stressors, leverage resources, and reduce social stigma associated with food insecurity and accessing nutrition and mental health assistance. This may improve their household food security and mitigate the burden of stressors on their mental health because system-level solutions to food insecurity are pursued.

Mother-infant postnatal experience and its association with maternal emotion and coping during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic resulted in a partial lockdown in Malaysia known as Movement-Controlled-Order (MCO), which has affected primary care management and social life norms. Thus, psychological health is a concern for mothers, particularly during the postpartum period. This study aimed to determine factors associated with maternal emotional experiences and coping during the pandemic.

METHODOLOGY

Mothers of infants aged < 18 months (n = 1449) in Malaysia completed an online survey during MCO (July 2020 to February 2021). The survey comprised questions on sociodemographics, pandemic livelihood impact, maternal experiences, and emotions.

RESULTS

More than one-third of mothers expressed feeling worried (54.7%), annoyed (48.1%), and tired (42.2%) to some or a high extent. Mothers who were younger (p = .001), more educated (p = .001), faced difficulty paying rent (p = .002), and whose husbands were unemployed (p < .001) expressed higher negative emotions. In contrast, mothers who received enough support for health (p = .001) and breastfeeding (p = .008), had infants sleep less (p = .042) and had more time to focus on health (p < .001) expressed better emotions. Higher coping was expressed among mothers with a higher household income (p = .004), had more time to focus on their health (p = .010), received additional breastfeeding support (p = 0.039), and practised traditional postpartum care (p < .001). In contrast, difficulty paying for essentials (p = .023) was associated with negative coping.

CONCLUSION

Maternal emotional experiences were significantly associated with sociodemographic characteristics, livelihood impact, postnatal experiences, and infant behaviours. Postpartum mental health screening is recommended to prevent severe distress, especially in first-time mothers. Coping interventions for mothers at risk may include comprehensive support and maternity care.

Phenotyping the autonomic nervous system in pregnancy using remote sensors: potential for complication prediction

Objectives: The autonomic nervous system (ANS) plays a central role in dynamic adaptation during pregnancy in accordance with the pregnancy demands which otherwise can lead to various pregnancy complications. Despite the importance of understanding the ANS function during pregnancy, the literature lacks sufficiency in the ANS assessment. In this study, we aimed to identify the heart rate variability (HRV) function during the second and third trimesters of pregnancy and 1 week after childbirth and its relevant predictors in healthy pregnant Latina individuals in Orange County, CA. Materials and methods: N = 16 participants were enrolled into the study from which N = 14 (N = 13 healthy and n = 1 complicated) participants proceeded to the analysis phase. For the analysis, we conducted supervised machine learning modeling including the hierarchical linear model to understand the association between time and HRV and random forest regression to investigate the factors that may affect HRV during pregnancy. A t-test was used for exploratory analysis to compare the complicated case with healthy pregnancies. Results: The results of hierarchical linear model analysis showed a significant positive relationship between time (day) and average HRV (estimated effect = 0.06; p < 0.0001), regardless of being healthy or complicated, indicating that HRV increases during pregnancy significantly. Random forest regression results identified some lifestyle and sociodemographic factors such as activity, sleep, diet, and mental stress as important predictors for HRV changes in addition to time. The findings of the t-test indicated that the average weekly HRV of healthy and non-healthy subjects differed significantly (p < 0.05) during the 17 weeks of the study. Conclusion: It is imperative to focus our attention on potential autonomic changes, particularly the possibility of increased parasympathetic activity as pregnancy advances. This observation may challenge the existing literature that often suggests a decline in parasympathetic activity toward the end of pregnancy. Moreover, our findings indicated the complexity of HRV prediction, involving various factors beyond the mere passage of time. To gain a more comprehensive understanding of this dynamic state, future investigations should delve into the intricate relationship between autonomic activity, considering diverse parasympathetic and sympathetic metrics, and the progression of pregnancy.

Food Insecurity and Psychological Distress Amongst Parenting Women in Treatment for Opioid Use: Identifying Barriers to Nutritional Equity and Implications for Future Intervention Research

PURPOSE

To describe the prevalence of food insecurity among pregnant and parenting women with opioid use disorder (OUD), its association with psychosocial health, and their experience with the Special Supplemental Nutrition Program for Women Infant Child (WIC) program.

DESIGN

This cross-sectional study collected survey data through REDCAP.

SETTING

The study was conducted at a single, urban, opioid treatment program.

SUBJECTS

A total of 91 female participants (≥18 years of age and receiving OUD treatment services) were approached about the study and all consented.

MEASURES

Measures included: US Household Short Form Food Security Survey, Patient Health Questionnaire 4(PHQ4), Perceived Stress Scale (PSS), and a demographics and food behavior survey.

ANALYSIS

Descriptive analyses (frequency, means) described data and Chi-Square, Fischer's exact, t-tests were used to compare data between food security groups.

RESULTS

Participants were on average 34 years old, Caucasian (68%), and non-Hispanic (87%). Most reported low (32%) to very low (33%) food security. Pearson correlation analyses indicate a strong positive linear relationship between Food Security Score and PHQ4 Total (P = .0002), PHQ4 Depression (P = .0003), PHQ4 Anxiety (P = .0009), and PSS Total (P < .0001). Only 38% felt the foods available in WIC supported their breastfeeding. Limitations include a single site and recall bias.

CONCLUSIONS

Significant nutritional inequity in families affected by maternal substance use exists, with potential for adverse maternal and child development related implications.

The association of the quality of life with Afghan households' food insecurity before and after the recent political change in Afghanistan: a comparative analysis

The overreaching objective of the current study is to investigate the association of quality of life with Afghan households' food insecurity. The data was collected immediately after the Taliban took control of a large part of Afghanistan. About a total of 555 households' heads participated in a face-to-face interview, using the HFIAS and WHOQOL-100 questionnaires along with some questions related to their socioeconomic characteristics at two different times, before and after the Taliban's takeover. The comparative analysis showed that 98% of Afghan households were food insecure after the Taliban takeover, while 70% of them faced food insecurity before the Taliban's takeover. The quality of life in the Taliban era is worse than before the Taliban. All dimensions of quality of life have decreased, and this decrease was more pronounced for the psychological, environmental, and physical domains. It is recommended that international organizations, NGOs, and local agents focus on these dimensions of the quality of life to improve food security.

Is household food insecurity related to mothers' stress, anxiety and depression in Iran?

Food insecurity is a public health concern with pervasive effects on numerous human biological factors. In addition to physical problems, food insecurity may have adverse social and psychological impacts. The present study aimed to determine the correlations between household food insecurity and stress, anxiety, and depression in mothers living in Mashhad, Iran. In this cross-sectional study we recruited 312 mothers. We collected data on the food insecurity status of households using the Household Food Insecurity Access Scale (HFIAS) and used the Depression Anxiety Stress Scale (DASS) to assess the levels of stress, anxiety, and depression in the subjects. The prevalence rate of food insecurity was 51.9%, and the prevalence rate of stress, anxiety, and depression was 70.2%, 70.2%, and 55.1%, respectively. In the food-insecure group, 94.3% of the mothers had stress, 91.4% had anxiety, and 87.1% had depression. While in the food-secure group, 60.7%, 61.3%, and 37.3% of the mothers had stressed, anxiety, and depression, respectively. In all the analytical models, food insecurity was significantly and positively associated with stress, anxiety, and depression (P < 0.001). Our results suggested that a higher level of food insecurity correlates with extreme degrees of stress, anxiety, and depression. Therefore, the improvement of mothers' mental health in terms of stress, anxiety, and depression depends on the improvement of household food insecurity.

Food Insecurity during the Pandemic in South Korea: The Effects of University Students' Perceived Food Insecurity on Psychological Well-Being, Self-Efficacy, and Life Satisfaction

This study examined the impact of university students' perceptions of food insecurity on psychological well-being, self-efficacy, and life satisfaction and observed that the students' gender plays a moderating role in this causal relationship, based on a total of 491 university students who participated in this empirical study. This study used SPSS (Version 22.0) and AMOS (Version 20.0) for the analyses. This study examines the structural relationship of this causal model. Our findings suggest that students' perceived food insecurity negatively affects the status of their psychological well-being and self-efficacy. However, contrary to expectations, perceived food insecurity has no negative effects on students' life satisfaction. In addition, the level of students' psychological well-being positively influences their life satisfaction, while self-efficacy does not. The moderating effects of gender differences in this research were also disclosed. Limitations and future research directions are also discussed.

Home-prepared meals among college students at-risk for food insecurity: A mixed-methods study

The ability to prepare meals at home is an important life skill with potential to improve dietary quality and reduce costs and thus may be particularly important for college students with food insecurity. However, heavy time demands, limited financial resources, and therefore other barriers such as lack of motivation to follow a healthy diet may constrain meal preparation skills. To gain greater insight into this issue, we conducted a mixed-methods study. The quantitative component assessed relationships among food security, motivation, and meal preparation skills. The qualitative component used focus groups to more closely consider college students' perceptions, values, and barriers surrounding preparing meals at home, including current practices, desired future practices, and the ways in which the campus could support their efforts. The survey (n = 226) assessed food security, meal preparation skills, and motivation (i.e., perceived ability and willingness) to consume a healthy diet. Ten focus groups (n = 60) discussed food choice, meal preparation practices, and ways in which the campus could help students develop meal preparation skills. Students with food insecurity had lower meal preparation skills and lower perceived ability to consume a healthy diet. However, a) willingness to consume a healthy diet and b) the impact of both willingness and perceived ability did not differ by food security status. Focus group data indicated that in-person and online cooking classes, information cards in the food pantry, and incentives (e.g., kitchen equipment and vouchers from local grocery stores) were popular ideas for improving home-meal preparation. A greater understanding of meal preparation skills and their interconnectedness to food choice and the campus environment may inform effective ways to support the ability and willingness of college students with food insecurity to prepare meals at home.

Tools for Screening and Measuring Anxiety Among Women Living with HIV of Reproductive Age: A Scoping Review

Emerging evidence suggests that women living with HIV (WLWH) may experience higher rates of anxiety than men living with HIV and women living without HIV. To date, relatively little knowledge exists on valid anxiety screening and diagnostic tools and how they are used among WLWH, specifically WLWH of reproductive age. Thus, the purpose of this scoping review was to describe what is known in the published literature about anxiety among WLWH and the tools used to measure and screen for anxiety in clinical and research contexts. The Arksey and O'Malley methodological framework was used to guide a scoping review of published articles in PsycINFO, Scopus, Sociological Abstracts, and PubMed databases. Twenty-one measures of anxiety were used across the 52 articles identified in the search. Most measures used were self-report. Inconsistencies in standardized screening tools and cutoff scores were observed across studies. Further, measures to assess anxiety varied among studies focused on WLWH. Based on the results from this review, there is a need for consistent, valid measures of anxiety to advance research and clinical practice to support the well-being of WLWH.

High levels of poor mental health among young men in urban informal settlements in South Africa: a community-based study of social determinants

Informal settlements (high population density areas at the outskirts of urban areas characterized by lack basic amenities) in South Africa are consequences of apartheid regime's discriminatory migrant labour and spatial policy and continue to grow. Living in informal settlements accompanies a mire of social/health challenges that threatens upward mobility, but few studies exist that document drivers of mental health challenges in these settings. We investigated the prevalence and social determinants of poor mental health for young men in informal settlements adjacent to one of the largest cities that is at the heart of HIV endemic in South Africa. This study involved a cross-sectional study with cluster sampling design of 674 young men aged 18-30 years residing in eThekwini informal settlement communities. We assessed the prevalence, and social determinants, of significant depressive (i.e., depression) and post-traumatic stress (i.e., PTS) symptoms using logistic regression. Given the complex survey design of the study, all analyses were adjusted for clustering. The prevalence of depression and PTS in the sample was 46.8% and 14.4% respectively. Results of the multivariable analyses indicated that severe food insecurity (aOR = 2.98, 95% CI:1.70-5.22), crime perpetration (aOR = 1.51, 95% CI:1.05-3.80), severe adverse childhood event (aOR = 2.00, 95% CI: 1.05-3.80), traumatic event exposures (aOR = 2.43, 95% CI:1.56-3.80) and problematic alcohol use (aOR = 1.73, 95% CI:1.20-2.49) were significantly associated with depression. While incomplete secondary education (aOR = 0.45, 95% CI:0.22-0.92), moderate food insecurity (aOR = 2.51, 95% CI:1.04-6.06), traumatic event exposures (aOR = 2.19, 95% CI:1.32-3.64) and problematic alcohol use (aOR = 2.15, 95% CI: 1.24-3.73) were significantly associated with PTS. Our study highlights the exceedingly high levels of poor mental health among young men in informal settlements, with depression and PTS being driven by economic/social conditions. Multilevel interventions that address the individual, interpersonal, and social variables that contribute to poor mental health are needed.

The association between food insecurity and cognitive impairment among the US adults: The mediation role of anxiety or depression

BACKGROUND

Using a nationally representative sample, this study aimed to examine (1) socio-demographic and health-related disparities in cognitive impairment, (2) the association between food insecurity and cognitive impairment, and (3) the mediation role of anxiety or depression in the pathway between food insecurity and cognitive impairment.

METHODS

Cross-sectional data of 28,508 adults from the 2020 National Health Interview Survey were analyzed. Multivariable logistic regression models were used to estimate associations with cognitive impairment. Mediation analyses were conducted using the four-way decomposition method under a counterfactual framework.

RESULTS

Disparities in cognitive impairment were observed across socio-demographic and health-related characteristics (all p < 0.0001). Food insecurity was significantly associated with cognitive impairment in the overall population and the magnitude of the association was greater for the young or middle-aged, females and non-Hispanic Blacks than the general population (AOR ranged from 1.19 to 2.54, all p < 0.01). With anxiety as a mediator, 28.66 % of the total effect of food insecurity on cognitive impairment was attributable to mediation only, and 22.39 % was attributable to interaction (between food insecurity and anxiety) and mediation. With depression as a mediator, 22.33 % of the total effect was attributable to mediation only, and 16.00 % was attributable to interaction (between food insecurity and depression) and mediation.

LIMITATIONS

The cross-sectional design prevents inference of causality.

CONCLUSIONS

Ensuring available and adequate food resources is important to prevent adverse cognitive outcomes. Clinical interventions or treatments for anxiety or depression may help improve cognitive function.

Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States

PURPOSE

Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions.

METHODS

Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions.

FINDINGS

Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress.

CONCLUSIONS

In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.

Food insecurity and insomnia-related symptoms among adults from low- and middle-income countries

Little is known about the relationship between food insecurity and sleep problems in low- and middle-income countries, while the mediators of this association are largely unknown. Therefore, we investigated the association between food insecurity and insomnia-related symptoms in six low- and middle-income countries (i.e., China, Ghana, India, Mexico, Russia, South Africa), and the potential mediators of this relationship. Cross-sectional, nationally representative data from the Study on Global AGEing and Adult Health (2007-2010) were analysed. Past 12-month food insecurity was assessed with two questions on the frequency of eating less, and on hunger owing to a lack of food. Insomnia-related symptoms referred to severe or extreme sleep problems in the past 30 days. Multivariable logistic regression and mediation analysis were conducted. Data on 42,489 adults aged ≥18 years were analysed (mean [standard deviation] age 43.8 [14.4] years; 50.1% females). The prevalence of any food insecurity and insomnia-related symptoms was 11.9% and 4.4%, respectively. After adjustment, compared with no food insecurity, moderate (odds ratio = 1.53, 95% confidence interval = 1.11-2.10) and severe food insecurity (odds ratio = 2.35, 95% confidence interval = 1.56-3.55) were significantly associated with insomnia-related symptoms. Anxiety, perceived stress, and depression mediated 27.7%, 13.5%, and 12.5% of the relationship between any food insecurity and insomnia-related symptoms, respectively (total percentage = 43.3%). Food insecurity was positively associated with insomnia-related symptoms in adults from six low- and middle-income countries. Anxiety, perceived stress, and depression explained a substantial proportion of this relationship. Addressing food insecurity itself or the identified potential mediators among people with food insecurity may lead to a reduction in sleep problems among adults in low- and middle-income countries, pending confirmation with longitudinal studies.

Mental health and HIV risk differs by co-occurring structural vulnerabilities among women who sell sex

Female sex workers (FSW) experience many structural vulnerabilities (SV; e.g., violence, economic insecurity) which contribute to increased risk of HIV and mental distress. However, little research has examined how SV co-occur to shape HIV risk, and none have studied mental distress. Among FSW (n = 385) in Baltimore, Maryland, latent class analysis of five binary indicators (housing insecurity; financial dependence on others; client-perpetrated physical or sexual violence; food insecurity) determined classes of SV and differential HIV risk behavior and mental health outcomes. A 3-class model fit the data best: minimal SV (i.e., low probabilities of all indicators); material needs (i.e., housing, food insecurity); and high SV (i.e., high probability of all indicators). Compared to minimal SV, high SV and material needs had significantly greater adjusted probability of drug injection and poorer adjusted depression, post-traumatic stress disorder, and mental distress scores. The high SV class had significantly higher probability of reporting condomless sex with clients compared to material needs and minimal SV. Results show the deleterious effect of co-occurring SV on HIV risk behaviors among FSW with particular emphasis on co-occurring food and housing insecurities. This is the first study of co-occurring SV on mental health outcomes in this key population.

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

BACKGROUND

Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality.

METHODS

In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable.

RESULTS

At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide.

CONCLUSIONS

The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.

Food security for survivors of intimate partner violence: Understanding the role of food in survivor well-being

Intimate partner violence (IPV) and food security are two leading public health issues that disproportionately impact women in the United States. Despite this connection, the relationship between IPV and food security has been relatively unexplored. While food security is a known factor in increased well-being, it is not often explicitly included in care for survivors. As part of a larger study on survivors of domestic violence who are receiving services from a domestic violence and sexual assault agency in the Southern United States, we analysed participant responses (n = 26) to various scales (i.e. depression, anxiety, PTSD, disability, well-being, hope, food security) to determine the relationships between mental health and food-related variables. Importantly, findings from our study show that survivors experience low food security at higher rates (53.8%) than the U.S. national average (11.5%). Additionally, the proportion of survivors in our sample who are receiving some form of food aid and remain food insecure is high (26.9%), leading to questions about the adequacy of food aid. Finally, our results underpin the relationship between food security and mental health for survivors, as low food security is positively correlated with depression, PTSD, disability, trouble concentrating, lack of hope and decreased well-being. These findings have implications for how we evaluate food security and the role it plays in well-being for survivors.

An invisible villain: high perceived stress, its associated factors, and possible consequences in a population-based survey in southern Brazil

INTRODUCTION

Much of the evidence on the relationship between stress, lifestyle, and other physical and mental health outcomes comes from studies conducted in high-income countries. There is therefore a need for research among populations in low and middle-income settings.

OBJECTIVES

To measure stress levels and identify factors associated with a high stress level and its consequences for health.

METHODS

This was a population-based cross-sectional study carried out in 2016 with adults aged 18 years or older in a municipality in southern Brazil. A two-stage sampling strategy based on census tracts was used. Stress levels were measured with the Perceived Stress Scale (PSS-14) and classified into quartiles. The impact of the highest stress levelon each outcome was assessed with etiologic fractions (EF).

RESULTS

The most stressed groups were: females (PR = 1.51, 95%CI 1.25-1.81), younger people (PR = 1.76, 95%CI 1.26-2.46), middle-aged individuals (PR = 1.60, 95%CI 1.17-2.19), those with lower schooling (PR = 1.56, 95%CI 1.20-2.02), the physically inactive (PR = 1.51, 95%CI 1.20-1.91), people who spent three or more hours watching television per day (PR = 1.29, 95%CI 1.12-1.50), and those with food insecurity (PR = 1.44, 95%CI 1.19-175). Possible consequences of high stress level were regular or poor self-perception of health (EF = 29.6%), poor or very poor sleep quality (EF = 17.3%), lower quality of life (EF = 45.6%), sadness (EF = 24.2%), and depressive symptoms (EF = 35.8%).

CONCLUSIONS

Stress plays an important role in several domains of health. Both public policies that target reduction of inequalities and specific stress-management interventions can reduce stress levels in populations, thereby decreasing the burden of other negative physical and mental health outcomes related to stress.

Serum adiponectin-levels are predictive of probable posttraumatic stress disorder in women

Background

Accumulative evidence indicates a role for adiponectin, a polypeptide secreted by adipose tissue, in the pathophysiology of posttraumatic disorder (PTSD) via metabolic and inflammatory pathways. This study examined adiponectin as a potential predictive biomarker for PTSD among female rape survivors.

Methods

We evaluated the relationship of baseline serum adiponectin levels to the development of probable PTSD at 3- and 6-months post rape-exposure and compared adiponectin levels between 542 rape-exposed (RE) and 593 rape-unexposed women (RUE). Probable PTSD were defined as Davidson Trauma Scale score ≥40. Data were analysed using multivariate regression models and a generalized estimating equation (GEE) model. We adjusted for clinically relevant covariates associated with PTSD, as well as adiposity indices.

Results

Participants who were in the mid-and high adiponectin tertile groups versus the lowest tertile group had a significantly reduced risk of probable PTSD among at 6 months follow-up, independent of adiposity(aOR = 0.45[0.22–1.05], p = 0.035; aOR = 0.44[0.22–0.90], p = 0.024). However, there was no effect of group (RE vs. RUE).

Limitations

Adiponectin assays were conducted on non-fasting blood samples and information on chronic medication, dietary factors and levels of physical activity were not collected. There was a high attrition rate among rape exposed participants.

Conclusions

Our results show that higher serum adiponectin levels are associated with reduced risk of probable PTSD over a 6-month period. This finding supports the hypothesis that serum adiponectin is a potential risk biomarker for PTSD.

•

The prospective associations between adiponectin, an anti-inflammatory cytokine and development of PTSD was examined in a cohort of rape exposed women.

•

Serum adiponectin levels were inversely associated with probable PTSD at 6 month among control but not rape exposed women.

•

Results suggest that adiponectin may serve as a potential risk biomarker of PTSD.

Food Insecurity and Health-Related Concerns Among Elementary Schoolteachers During the COVID-19 Pandemic

Introduction

US school systems underwent major upheaval, including closures, implementation of virtual and/or hybrid learning, and stringent infection mitigation protocols, during the initial phase of the COVID-19 pandemic. We aimed to examine the association between food insecurity and perceived health, perceived stress, and social determinants of health concerns among elementary schoolteachers serving predominantly low-income children during the COVID-19 pandemic.

Methods

Brighter Bites, a nonprofit organization that weekly distributes fresh fruits and vegetables and nutrition education materials to more than 300 schools serving racial and ethnic minority populations with low income, conducts annual surveys of participating teachers to help determine subsequent efforts to support schools and families during the school year. We analyzed self-reported data collected electronically by the Brighter Bites teachers survey in 76 elementary schools during summer 2020. We used generalized linear mixed models to measure the association between food insecurity and health-related concerns.

Results

Of 862 teachers who responded to the survey, 685 answered the 2 questions about food insecurity status; of these, 199 (29.1%) reported experiencing food insecurity. Food insecurity was positively associated with poor perceived general health, greater perceived stress, concerns about various social determinants of health, and changes in fruit and vegetable consumption during the COVID-19 pandemic.

Conclusion

Our study demonstrated the high prevalence of food insecurity and highlights its associated factors among elementary schoolteachers during the COVID-19 pandemic. It calls attention to the high correlation of various concerns among elementary schoolteachers during the COVID-19 pandemic. Further intervention and policy efforts are needed to relieve food insecurity–related concerns and enhance well-being among teachers.

A Heavy Burden: Preexisting Physical and Psychiatric Comorbidities and Differential Increases Among Male and Female Participants After Initiating Antiretroviral Therapy in the HIV Outpatient Study, 2008-2018

Attention to non-AIDS comorbidities is increasingly important in the HIV care and management in the United States. We sought to assess comorbidities before and after antiretroviral therapy (ART) initiation among persons with HIV (PWH). Using the 2008-2018 HIV Outpatient Study (HOPS) data, we assessed changes in prevalence of physical and psychiatric comorbidities, by sex, among participants initiating ART. Cox proportional hazards models were fit to investigate factors associated with the first documented occurrence of key comorbidities, adjusting for demographics and other covariates, including insurance type, CD4⁺ cell count, ART regimen, and smoking status. Among 1,236 participants who initiated ART (median age 36 years, CD4 cell count 375 cells/mm³), 79% were male, 66% non-white, 44% publicly insured, 53% ever smoked, 33% had substance use history, and 22% had body mass index ≥30 kg/m². Among females, the percentages with at least one condition were: at ART start, 72% had a physical and 42% a psychiatric comorbidity, and after a median of 6.1 years of follow-up, these were 87% and 63%, respectively. Among males, the percentages with at least one condition were: at ART start, 61% had a physical and 32% a psychiatric comorbidity, and after a median of 4.6 years of follow-up, these were 82% and 53%, respectively. In multivariable Cox proportional hazards analyses, increasing age and higher viral loads (VL) were associated with most physical comorbidities, and being a current/former smoker and higher VL were associated with all psychiatric comorbidities analyzed. HOPS participants already had a substantial burden of physical and psychiatric comorbidities at the time of ART initiation. With advancing age, PWH who initiate ART experience a clinically significant increase in the burden of chronic non-HIV comorbidities that warrants continued surveillance, prevention, and treatment.

Understanding the drivers of food security among agriculture-based households in Gurué District, Central Mozambique

BACKGROUND

The prevalence of food insecurity in Mozambique is alarming, despite progress made during the 2010s. Several studies apply different proxy indicators of food security (FS) to assess the FS situation. However, these studies overlook the factors affecting FS, using only a single data point that results in an incomplete picture of FS. Food security is expected to fluctuate, being better and worse than what studies suggest. Using a sample of 296 households to assess FS, key drivers conditioning households' capacity to achieve FS in Gurué District, Central Mozambique, are identified. Data were collected in the pre-harvest period and during the harvest period to capture relevant interseasonal variation of FS. Household FS is assessed using three standard indicators: Household Dietary Diversity Score (HDDS), Household Food Consumption Score (HFCS), and Months of Adequate Household Food Provisioning (MAHFP).

RESULTS

Each household was classified into a specific FS status depending on the indicator applied. Generally, most households were classified as being severely or moderately food insecure during the pre-harvest season, while during the harvest season, medium and high levels of FS predominated. Nevertheless, varying outcomes were found depending on the indicator used to assess FS. MAHFP and HDDS are more related to the consumption of farm-sourced food, while HFCS responds more strongly to purchased food. Gender and age of the household head, geographic location, size and quality of land, staples production (especially cassava), livestock and crop diversity, as well as cash crops had a statistically significant effect on FS indicators.

CONCLUSIONS

The study concludes that the decision whether farmers should rely on staple foods production for increasing their FS status or specialize on cash crops production to generate income and buy food depends on the indicator used to assess FS, since each indicator captures a specific domain of food security. Thus, one central recommendation derived from our results is that policy makers should promote a balance between market-oriented agriculture and subsistence production to achieve FS.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s40066-021-00344-3.

Evaluating the Full Plate Living lifestyle intervention in low-income monolingual Latinas with and without food insecurity

Introduction:

Food insecurity has long been associated with poor physical and mental health, especially among women from underrepresented minorities. Despite efforts to reduce food insecurity, rates continue to rise and remain disproportionately high among Latinx living in the United States, a group reporting worse mental health symptoms than any other ethnic group during the COVID-19 pandemic. The need to reduce the health burden associated with food insecurity among Latinas is urgent and requires a more targeted and innovative approach. Interventions using a popular education approach have proven effective among underserved populations, especially when these are delivered by community health workers. However, food insecurity status of the participants is often unreported and it is not clear whether or not results vary between those with and without food insecurity.

Objectives:

The aim of this quasi-experimental study was to examine physical and mental health changes among Latinas with, and without, food insecurity following a multicomponent health intervention led by community health workers using a popular education approach.

Methods:

Enrolled obese Latinas (N = 98) with and without food insecurity responded to demographic, health behaviors and mental health surveys and completed biometric measurements at baseline, immediately following the intervention and at 3 months.

Results:

At baseline, participants with food insecurity reported more anxiety and depression than those without, but average body mass index was comparable. Depression, anxiety and body mass index were lower at 3 months post and no statistically significant differences were seen between the groups. Participants with food insecurity benefited as much from the intervention as those without.

We found that, although community health workers are not licensed healthcare professionals, with proper training and support, they were able to successfully reduce the risk of chronic diseases and improve mental health symptoms among food-insecure Latinas.

Conclusion:

Given the promising results, similar interventions should be implemented on a larger scale in Latino communities among food insecure women. Long-term sustainability should also be explored.

Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV

PURPOSE OF THE REVIEW

By reviewing the most recent common mental health disorders (CMHD) studies in people living with HIV (PLWH) (2018-2020), this review discusses the prevalence of CMHD, factors associated with CMHD in PLWH, mental health in PLWH from vulnerable groups, the impact of CMHD on HIV disease progression and adherence to antiretroviral therapy and the efficacy of different treatment approaches.

RECENT FINDINGS

After screening for eligibility 142 studies were included in the final systematic review. Only 27% of studies were conducted in Sub-Saharan Africa, which carries the highest burn of HIV disease globally. Despite the well-established increased risk of CMHD in PLWH, the current prevalence remains high, with studies reporting 28%-62% of PLWH having mental health symptoms.

CONCLUSION

Despite the significant challenges that CMHDs present to successful HIV treatment, there are many mental health treatments and interventions which can improve outcomes in PLWH and opportunities to task-shift and integrate mental health care with HIV care.

Association of Household Food Insecurity with Nutritional Status and Mental Health of Pregnant Women in Rural Bangladesh

Food insecurity may affect women’s health; however, pertinent research is scant among pregnant women. This study investigated the association of household food insecurity (HFI) with the nutritional status and mental health of 672 early-gestation (5–16 weeks) pregnant women with a singleton fetus, who participated in the screening activity of a community-based trial (NCT04868669) in Matlab, Bangladesh. Height (cm), weight (kg), body mass index (kg/m²), mid-upper arm circumference (MUAC) (cm), depression, anxiety, and stress were the outcomes studied. HFI was assessed using the Household Food Insecurity Access Scale. Women’s depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scales-21. Propensity score matching based weighted multivariable linear and logistic regression were used to evaluate the independent association of HFI with the outcomes. In adjusted models, pregnant women from food-insecure households in rural Matlab were on average 2.0 cm shorter (β = −2.0, 95% CI: −3.3, −0.7), 2.0 kg lighter (β = −2.0, 95% CI: −3.4, −0.7), and had 0.6 cm lower MUAC (β = −0.6, 95% CI: −1.1, −0.1) than their food-secure counterparts. HFI was associated with higher odds of depression (OR = 3.3, 95% CI: 1.8, 5.9), anxiety (OR = 6.1, 95% CI: 3.7, 10.0), and stress (OR = 4.8, 95% CI: 1.6, 14.2) among the women. Public health measures should focus on ensuring proper nutrition during the critical growth periods of life, pregnancy, and external environmental shocks, to mitigate the adverse effects of HFI on women’s health.

Food insecurity risk and alcohol use disorder in US young adults: Findings from the National Longitudinal Study of Adolescent to Adult Health

BACKGROUND AND OBJECTIVES

The relationship between food insecurity and alcohol use disorder remains unknown. The aim of this study was to determine the association between food insecurity risk and alcohol use disorder in a nationally representative sample of young adults.

METHODS

Cross-sectional nationally representative data of 14,786 US young adults aged 24-32 years old from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed to assess a single-item measure of food insecurity risk and Diagnostic and Statistical Manual, 5th Edition (DSM-5) alcohol use disorder.

RESULTS

Among young adults, 12% were found to be at risk for food insecurity. Young adults with food insecurity risk had greater odds of moderate (adjusted odds ratio [AOR]: 1.34, 95% confidence interval [CI]: 1.13-1.58) and severe (AOR: 1.67, 95% CI: 1.34-2.07) threshold alcohol use disorder than food-secure young adults, adjusting for age, sex, race/ethnicity, education, income, receipt of public assistance, household size, and smoking. Food insecurity risk was also associated with a 23% higher (95% CI: 11%-37%) number of problematic alcohol use behaviors (e.g., risky behaviors, continued alcohol use despite emotional or physical health problems).

DISCUSSION AND CONCLUSIONS

Food insecurity risk is associated with problematic patterns of alcohol use. Health care providers should screen for food insecurity and problematic alcohol use in young adults and provide referrals for further resources and treatment when appropriate.

SCIENTIFIC SIGNIFICANCE

This nationally representative study of US young adults is the first to find an association between food insecurity risk and alcohol use disorder using DSM-5 criteria.

Material hardship is associated with posttraumatic stress disorder symptoms among low-income Black women

The link between socioeconomic status and posttraumatic stress disorder (PTSD) symptoms is well established. Given that Black women are disproportionately burdened by both poverty and PTSD symptoms, research focusing on these constructs among this population is needed. The current study assessed the association between material hardship (i.e., difficulty meeting basic needs) and PTSD symptoms among 227 low-income Black women in the United States. We explored several potential explanations for the association between poverty and PTSD symptoms (e.g., individuals living in poverty may experience higher levels of trauma exposure; individuals living in poverty may have less access to relevant protective resources, like social support; poverty itself may represent a traumatic stressor). Using robust negative binomial regression, a positive association between material hardship and PTSD symptoms emerged, B = 0.10, p = .009, SMD = 0.08. When trauma exposure was added to the model, it was positively associated with PTSD symptoms, B = 0.18, p < .001, SMD = 0.16, and material hardship remained positively associated with PTSD symptoms, B = 0.10, p =.019, SMD = 0.08. When social support indicators were added to the model, they were not associated with PTSD symptoms; however, material hardship remained significantly associated, B = 0.10, p = .021, SMD = 0.08. In the model with material hardship and trauma exposure, a significant interaction between material hardship and trauma exposure on PTSD symptoms emerged, B = -0.04, p = .027. These results demonstrate the importance of including material hardship in trauma research, assessment, and treatment.

Relationship between food insecurity and smoking status among women living with and at risk for HIV in the USA: a cohort study

OBJECTIVES

People living with HIV (PLHIV) in the USA, particularly women, have a higher prevalence of food insecurity than the general population. Cigarette smoking among PLHIV is common (42%), and PLHIV are 6-13 times more likely to die from lung cancer than AIDS-related causes. This study sought to investigate the associations between food security status and smoking status and severity among a cohort of predominantly low-income women of colour living with and without HIV in the USA.

DESIGN

Women enrolled in an ongoing longitudinal cohort study from 2013 to 2015.

SETTING

Nine participating sites across the USA.

PARTICIPANTS

2553 participants enrolled in the Food Insecurity Sub-Study of the Women's Interagency HIV Study, a multisite cohort study of US women living with HIV and demographically similar HIV-seronegative women.

OUTCOMES

Current cigarette smoking status and intensity were self-reported. We used cross-sectional and longitudinal logistic and Tobit regressions to assess associations of food security status and changes in food security status with smoking status and intensity.

RESULTS

The median age was 48. Most respondents were African-American/black (72%) and living with HIV (71%). Over half had annual incomes ≤US$12 000 (52%). Food insecurity (44%) and cigarette smoking (42%) were prevalent. In analyses adjusting for common sociodemographic characteristics, all categories of food insecurity were associated with greater odds of current smoking compared with food-secure women. Changes in food insecurity were also associated with increased odds of smoking. Any food insecurity was associated with higher smoking intensity.

CONCLUSIONS

Food insecurity over time was associated with smoking in this cohort of predominantly low-income women of colour living with or at risk of HIV. Integrating alleviation of food insecurity into smoking cessation programmes may be an effective method to reduce the smoking prevalence and disproportionate lung cancer mortality rate particularly among PLHIV.

Association between Food Insecurity, Mental Health, and Intentions to Leave the US Army in a Cross-Sectional Sample of US Soldiers

BACKGROUND

Previous research has demonstrated that certain groups in the United States are at a greater risk for food insecurity. However, food insecurity has not been sufficiently characterized in active duty military populations.

OBJECTIVES

The primary objective of this study was to determine the prevalence of marginal food insecurity at a large US Army installation. The secondary objective was to determine how marginal food insecurity may be associated with intentions to leave the US Army after the current service period ("intentions to leave").

METHODS

A cross-sectional, online survey was administered by the US Army Public Health Center at an Army installation in 2019 (n = 5677). The main predictor was the 2-item food insecurity screener (Hunger Vital Signs), and the main outcome was a 5-point Likert question, "How likely are you to leave the army after your current enlistment/service period?" that was dichotomized for this analysis. Multiple logistic regression was used to assess the association between marginal food insecurity and intentions to leave. Mental health covariates were analyzed as a potential mediator.

RESULTS

The sample was primarily male (83%), age <25 y (49%), and White (56%). One-third of respondents were classified as marginally food insecure using the Hunger Vital Signs, and 52% had intentions to leave. There was no significant association between marginal food insecurity and intentions to leave in the composite multivariable model, but mediation analyses revealed that food insecurity was significantly and independently associated with anxiety, depression, and suicidal ideation, which was in turn associated with intentions to leave.

CONCLUSIONS

The association between marginal food insecurity and mental health showed that addressing food insecurity could improve mental health and subsequently reduce intentions to leave. Solutions to reduce military food hardship include expanding Supplemental Nutrition Assistance Program eligibility requirements, improving food resources communication, and expanding healthy food choices on-post.

Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention

Background

Food insecurity and intimate partner violence (IPV) are associated with suboptimal HIV prevention and treatment outcomes, yet limited research has explored how food insecurity and IPV intersect to influence HIV-related behaviors. To fill this gap, we conducted a qualitative study with women living with or at risk for HIV in the United States.

Methods

We conducted 24 in-depth interviews with women enrolled in the San Francisco and Atlanta sites of the Women’s Interagency HIV study (WIHS). Participants were purposively sampled so half were living with HIV and all reported food insecurity and IPV in the past year. Semi-structured interviews explored experiences with food insecurity and IPV, how these experiences might be related and influence HIV risk and treatment behaviors. Analysis was guided by an inductive-deductive approach.

Results

A predominant theme centered on how food insecurity and IPV co-occur with poor mental health and substance use to influence HIV-related behaviors. Women described how intersecting experiences of food insecurity and IPV negatively affected their mental health, with many indicating using substances to “feel no pain”. Substance use, in turn, was described to perpetuate food insecurity, IPV, and poor mental health in a vicious cycle, ultimately facilitating HIV risk behaviors and preventing HIV treatment adherence.

Conclusions

Food insecurity, IPV, poor mental health and substance use intersect and negatively influence HIV prevention and treatment behaviors. Findings offer preliminary evidence of a syndemic that goes beyond the more widely studied “SAVA” (substance use, AIDS, and violence) syndemic, drawing attention to additional constructs of mental health and food insecurity. Quantitative research must further characterize the extent and size of this syndemic. Policies that address the social and structural drivers of this syndemic, including multi-level and trauma-informed approaches, should be implemented and evaluated to assess their impact on this syndemic and its negative health effects.

Disentangling the Relationship between Food Insecurity and Poor Sleep Health

The COVID-19 pandemic has created disruptions in global and national food supply chains. Along with an increase in the unemployment rate, this resulted in a rise in food insecurity at the community-level, threatening individual and family well-being. Food insecurity is associated with inadequate nutrient intakes, weight gain, and psychological distress, including anxiety and depressive symptoms, all of which are known to affect sleep. Yet, little is known about whether and how food insecurity is associated with sleep health, a critical but underrecognized health outcome. This paper reviews literature describing associations between food insecurity and sleep, summarizes key findings based on proposed mechanisms, and discusses directions for future research.

Association between food insecurity and fall-related injury among adults aged ≥65 years in low- and middle-income countries: The role of mental health conditions

PURPOSE

We investigated the association between food insecurity and fall-related injury among older adults from six low- and middle-income countries (LMICs), and the extent to which this association is mediated by mental health.

METHODS

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Fall-related injury referred to those that occurred in the past 12 months. Multivariable logistic regression analysis and mediation analysis were conducted to assess associations.

RESULTS

Data on 14,585 adults aged ≥65 years [mean (SD) age 72.5 (11.5) years; 54.9% females] were analyzed. After adjustment for potential confounders, severe food insecurity (versus no food insecurity) was associated with 1.95 (95%CI = 1.11-3.41) times higher odds for fall-related injury. Moderate food insecurity was not significantly associated with fall-related injury (OR = 1.34; 95%CI = 0.81-2.25). The mediation analysis showed that 37.3%, 21.8%, 17.7%, and 14.0% of the association between severe food insecurity and fall-related injury was explained by anxiety, sleep problems, depression, and cognition, respectively.

CONCLUSION

Severe food insecurity was associated with higher odds for injurious falls among older adults in LMICs, and a large proportion of this association may be explained by mental health complications. Interventions to improve mental health among those who are food insecure and a strong focus on societal and government efforts to reduce food insecurity may contribute to a decrease in injurious falls.

Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic

INTRODUCTION

During the COVID-19 pandemic, the rates of food insecurity and mental illness have been projected to increase in the U.S. owing to significant social and economic disruption. This study aims to estimate the prevalence of food insufficiency (often the most extreme form of food insecurity), the correlates of food insufficiency, and the associations between food insufficiency and symptoms of poor mental health in the U.S. during the COVID-19 pandemic.

METHODS

Cross-sectional data from 63,674 participants of the U.S. Census Household Pulse Survey were collected and analyzed in 2020. Multiple Poisson regression models were used to estimate associations with food insufficiency.

RESULTS

Food insufficiency rose from 8.1% to 10.0% from March to June 2020. Factors associated with food insufficiency included lower age, Black/African American or Latinx race/ethnicity, being unmarried, larger household size, recent employment loss, income below the federal poverty line, and lower education (all p<0.001). Food insufficiency was independently associated with all symptoms of poor mental health, adjusting for socioeconomic and demographic factors (adjusted RRs ranged from 1.16 to 1.42, all p<0.001). The association between food insufficiency and poor mental health was attenuated among people who received free groceries or meals.

CONCLUSIONS

Food insufficiency has increased during the COVID-19 pandemic and affects vulnerable populations, placing individuals at higher risk for symptoms of poor mental health. Particularly in the current crisis, clinicians should regularly screen patients for food insufficiency and mental health outcomes as well as provide support in accessing appropriate resources.

Emotional eating, binge eating, physical inactivity, and vespertine chronotype are negative predictors of dietary practices during COVID-19 social isolation: A cross-sectional study

Objectives

Coronavirus disease 2019 (COVID-19) emerged and rapidly spread worldwide. Several countries have imposed lockdown and isolation in attempt to mitigate viral spread. However, social isolation has a negative effect on psychological aspects, increasing stress, fear, anxiety, anger and emotional disturbance, as well as affecting sleep pattern and the practice of physical activity. Negative emotions and lifestyle changes trigger overeating, consequently affecting dietary practices. The aim of this study was to verify the prevalence of lifestyle factors (i.e., sleep time/quality and practice of physical exercise), eating behavior dimensions, chronotype, and association with dietary practices (planning, domestic organization, food choice, ways of eating) in home confinement during the COVID-19 pandemic in São Paulo, Brazil.

Methods

This cross-sectional study was conducted between April 27 and May 25, 2020. An anonymous online questionnaire (Microsoft Forms) was used for data collection by the snowball method. We verified dietary practices (outcome), eating behavior, physical exercise practice, sleep quality and duration, and chronotype (exposure variables). Sex, age, educational and social status were assessed as covariates and confounders. We evaluated 724 adults (585 women and 139 men). Mean age was 32.6 y (±11.3) for women and 33.5 y (±10.5) for men.

Results

Emotional eating (EE) and binge eating (BE) were positively correlated (r = 0.66; P <0.001). Dietary practices were negatively correlated with BE (r = –0.41; P <0.001), EE (r = –0.33; P <0.001) and body mass index (r = –0.24; P <0.001). Linear regression demonstrated that EE (β = –0.1351; t = –2.841; P = 0.005; η_p² = 0.013), BE (β = –0.2580; t = –5.612; P < 0.001; η_p² = 0.050), no practice of physical exercise at home (β = –0.4271; t = –5.933; P < 0.001; η_p² = 0.055), being vespertine (β = –0.3435; t = 2.076; P = 0.038; η_p² = 0.019), and age (β = –0.082; t = –2.210; P = 0.027; η_p² = 0.008) are negative predictors of dietary practices. Finally, cognitive restraint (β = 0.1407; t = 3.858; P < 0.001; η_p² = 0.024), better sleep quality (β = 0.1768; t = 2.506; P = 0.012; η_p² = 0.010), receiving 4–10 wages per month (according to a minimum wage in Brazil that corresponds to US $ 183.01) (β = 0.2568; t = 2.573; P = 0.10; η_p² = 0.027) and 10 – 20 wages per month (β = 0.4490; t = 3.726; P < 0.001; η_p² = 0.027) are positive predictors of dietary practices.

Conclusion

Eating behavior, physical exercise, sleep, and social factors can be important predictors for dietary practices during COVID-19 social confinement. Longitudinal studies in Brazil are needed to confirm these findings.

Associations between insecurity and stress among Chinese university students: The mediating effects of hope and self-efficacy

BACKGROUND

In the context of the pandemic, exploration on the association between insecurity and stress among university students is limited. The current study aims to investigate the parallel mediation role of hope and self-efficacy in the relationship between insecurity and stress among university students during the COVID-19 pandemic.

METHODS

We employed a cross-sectional research design in a university by distributing questionnaires online. 5286 participants were recruited (mean age = 19.65; SD = 1.13). Items were from the Security Questionnaire, Depression Anxiety and Stress Scale-21, and the Positive Psychology Capital (Psycap) Questionnaire (PPQ). Parallel mediation analysis was performed using PROCESS macro in SPSS.

RESULTS

The results indicate that insecurity predicted students' stress positively and that students with high-level perceived insecurity are more likely to perceive stress. Moreover, hope and self-efficacy mediated the relationship between insecurity and stress, indicating that hope and self-efficacy could buffer the negative effects of insecurity on stress.

LIMITATIONS

This study examines the mediating model between insecurity and stress among Chinese university students. The generalizability of the findings in other regions remains to be explored. Additionally, the roles of other positive self-beliefs including optimism and resilience in relieving stress can be further explored in future research.

CONCLUSIONS

This research provides direct evidence of insecurity effects on stress among university students, enriching relevant theories in the field of stress. Moreover, this research suggests that enhancing positive self-beliefs such as hope, and self-efficacy helps to relieve students' stress during COVID-19.

The Relationship between Food Security Status and Sleep Disturbance among Adults: A Cross-Sectional Study in an Indonesian Population

Background: The relationship between food insecurity and the experience of sleep disturbance has received little attention among researchers, although food insecurity is associated with poor physical and mental health globally. This study aimed to investigate the relationship between food security status and sleep disturbance among adults 20–64 years old. Methods: The study’s population-based sample included 20,212 Indonesian adults who participated in the fifth wave of the Indonesia Family Life Survey (IFLS5) in 2014. Dietary intake data, gathered using a food frequency questionnaire (FFQ), were used to assess the food security status. Sleep disturbance was assessed using the 10-item Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. We used multiple linear and logistic regression models to test the study hypothesis. Results: A higher likelihood of experiencing sleep disturbance was recorded in people aged older than 56 years (OR = 1.78, 95% CI: 1.17–2.72, p = 0.007), people with depressive symptoms (OR = 3.57, 95% CI: 2.77–4.61, p < 0.001), and food-insecure people (OR = 1.32, 95% CI: 1.02–1.70, p = 0.036). A lower likelihood of experiencing sleep disturbance was recorded in people with low educational attainment (OR = 0.41, 95% CI: 0.30–0.57, p < 0.001). Sleep disturbance was dependent on the food consumption groups and food security status among men (p = 0.004). Conclusions: Sleep disturbance may be affected by the food-insecure status of adults, and later, may lead to serious health outcomes.

A conceptual model for understanding the rapid COVID-19-related increase in food insecurity and its impact on health and healthcare

Food insecurity, a well-established determinant of chronic disease morbidity and mortality, is rapidly increasing due to the coronavirus disease 2019 (COVID-19) pandemic. We present a conceptual model to understand the multiple mechanisms through which the economic and public health crises sparked by COVID-19 might increase food insecurity and contribute to poor health outcomes in the short- and long-term. We hypothesize that, in the short-term, increased food insecurity, household economic disruption, household stress, and interruptions in healthcare will contribute to acute chronic disease complications. However, the impact of the pandemic on food security will linger after social-distancing policies are lifted and the health system stabilizes, resulting in increased risk for chronic disease development, morbidity, and mortality among food-insecure households in the long-term. Research is needed to examine the impact of the pandemic-related increase in food insecurity on short- and long-term chronic health outcomes, and to delineate the underlying causal mechanisms. Such research is critical to inform the development of effective programs and policies to address food insecurity and its downstream health impacts during COVID-19 and future pandemics.

Emotional Eating Mediates the Relationship Between Food Insecurity and Obesity in Latina Women

OBJECTIVE

To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in Latina women.

DESIGN

A secondary analysis of a cross-sectional study.

PARTICIPANTS

Women (n = 297) were recruited from a community health center in Lawrence, MA.

VARIABLES MEASURED

The 6-item US Department of Agriculture Household Food Security Scale was used to measure FI. The Three-Factor Eating Questionnaire Revised 18-item, version 2 was used to measure EE. Measured height and weight were used to calculate body mass index. Covariates included: age, education, marital status, number of children in the house, physical activity, and country of birth.

ANALYSIS

Multivariable logistic and linear regressions. Mediation was tested and the mediated proportion was calculated.

RESULTS

Overall, 36.7% of women experienced FI. In adjusted regression models, FI was positively associated with obesity (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.08-2.97; P = 0.02) and EE (β = 0.22; 95% CI, 0.001-0.44; P = 0.05), and EE was positively associated with obesity (OR = 1.82; 95% CI, 1.37-2.42; P < 0.01). When EE was included in the main effects model, FI was not significantly associated with obesity (OR = 1.64; 95% CI, 0.97-2.76; P = 0.06) and EE explained 21% of the association.

CONCLUSIONS AND IMPLICATIONS

Longitudinal studies are needed to confirm the findings. If the findings are confirmed, future studies can explore interventions to ameliorate EE among Latina women experiencing FI, and providers can screen for EE in Latinas experiencing FI.