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Julceus EF, Frongillo EA, Mendoza JA, Sauder KA, Malik FS, Jensen ET, Dolan LM, Bellatorre A, Dabelea D, Reboussin BA, Reynolds K, Pihoker C, Liese AD. Self-Reported Food Security in Adolescents with Type 1 Diabetes: Association with Hemoglobin A 1c and Mental Health Symptoms Independent of Household Food Security. J Nutr 2024; 154:543-553. [PMID: 38072157 PMCID: PMC10900134 DOI: 10.1016/j.tjnut.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Typically, child exposure to food insecurity is assessed by caregiver reports of household food security. Child report has the potential for greater accuracy because it pertains only to the child whose experiences may differ from caregiver reports. OBJECTIVE We assessed if adolescent-reported food insecurity was associated with levels of hemoglobin A1c (HbA1c), acute diabetes-related complications, depressive symptoms, and disordered eating behaviors in adolescents with type 1 diabetes, independently from household food security. METHODS In a cross-sectional analysis of the multicenter SEARCH for Diabetes in Youth Cohort Study (phase 4, 2016-2019) including 601 adolescents aged 10-17 y with type 1 diabetes and their caregivers, household food security, and adolescent-reported food security were assessed using the 18-item Household Food Security Survey Module and the 6-item Child Food Security Assessment questionnaire. Age-stratified (10-13 and 14-17) regression models were performed to estimate independent associations, adjusting for sociodemographics, clinical factors, and household food security. RESULTS Food insecurity was reported by 13.1% (n = 79) of adolescents and 15.6% (n = 94) of caregivers. Among adolescent-caregiver dyads, 82.5% (n = 496) of reports were concordant and 17.5% (n = 105) discordant, Cohen's κ= 0.3. Adolescent-reported food insecurity was not independently associated with HbA1c, diabetic ketoacidosis, and severe hypoglycemia, including in age-stratified analyses. Adolescent-reported food insecurity was independently associated with elevated odds of depressive symptoms [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.3, 10.3] and disordered eating behaviors (OR: 2.5, 95% CI: 1.4, 4.6) compared with adolescents reporting food security; these associations remained in both age groups for disordered eating behaviors and in the older group for depressive symptoms. CONCLUSIONS Adolescents with type 1 diabetes may experience food insecurity differently than caregivers. Adolescent-reported food insecurity was independently associated with depressive symptoms and disordered eating behaviors and thus may be an important attribute to assess in addition to household food security in adolescents with type 1 diabetes.
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Affiliation(s)
- Emmanuel F Julceus
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jason A Mendoza
- Fred Hutch Cancer Center, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Faisal S Malik
- Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Lawrence M Dolan
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
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McClain AC, Johnson CM, DiRado-Owens C, Dickin KL. How do Latina/o Parents Interpret and Respond to the US Household Food Security Survey Module? A Qualitative Cognitive Interviewing Study. J Acad Nutr Diet 2023; 123:S25-S45. [PMID: 37730305 PMCID: PMC10581700 DOI: 10.1016/j.jand.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The US Latino/a population disproportionately lives in poverty and experiences household food insecurity, especially households with children. The Household Food Security Survey Module (FSSM) was originally developed among rural White women. Despite wide use in English and Spanish, how well the FSSM captures the food insecurity experiences of Latino/a households is not well known. OBJECTIVE This study explored how Latino/a caregivers understood, interpreted, and perceived FSSM items and responses, and how well quantitative FSSM responses captured their reported food insecurity experiences. DESIGN Trained researchers conducted in-depth cognitive interviews in a qualitative study. PARTICIPANTS AND SETTING Interviews were conducted between October 2021 and August 2022 with Latino/a adults (N = 62) experiencing food insecurity while caring for a child (aged 18 years or younger) in the same household, and living in California, New York, or Texas. STATISTICAL ANALYSIS PERFORMED Qualitative analysis using iterative summaries for data reduction focused on item interpretation, response patterns, and cross-cutting themes. RESULTS Participants generally understood FSSM items as intended. The most salient findings were themes that applied across multiple FSSM items rather than wording issues with specific items. Underreporting of food insecurity was linked to nonaffirmative ("never") responses to items referencing not having enough money for food while describing reliance on nonmonetary resources (eg, food assistance or food pantries); emotional sensitivity to discussing food insecurity, particularly as it related to children; stigma and emotions related to skipping meals; and limited response options that participants believed did not reflect their experiences. These issues influenced multiple items, impeding ease of responding and leading to inaccurate responses in English- and Spanish-language versions. CONCLUSIONS Assessing coping strategies and providing more acceptable response options could enhance FSSM validity. Considering emic perspectives of Latino/a caregivers and how food access experiences differ from quantitative survey measures of food security could strengthen policy and programs.
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Affiliation(s)
- Amanda C McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California.
| | - Cassandra M Johnson
- School of Family and Consumer Sciences, Texas State University, San Marcos, Texas
| | | | - Katherine L Dickin
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York
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Pepetone A, Frongillo EA, Dodd KW, Wallace MP, Hammond D, Kirkpatrick SI. Prevalence and Severity of Food Insecurity Before and During the Coronavirus Disease 2019 Pandemic Among Adults and Youth in Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. J Nutr 2023; 153:1231-1243. [PMID: 36774229 PMCID: PMC9827674 DOI: 10.1016/j.tjnut.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Disruptions from the coronavirus disease 2019 (COVID-19) pandemic potentially exacerbated food insecurity among adults and youth. OBJECTIVES The objective was to examine changes in the prevalence and severity of food insecurity among adults and youth from before (2019) to during (2020) the pandemic in multiple countries. METHODS Repeated cross-sectional data were collected among adults aged 18-100 y (n = 63,278) in 5 countries in November to December in 2018-2020 and among youth aged 10-17 y (n = 23,107) in 6 countries in November to December in 2019 and 2020. Food insecurity in the past year was captured using the Household Food Security Survey Module and the Child Food Insecurity Experiences Scale. Changes in the prevalence and severity of food insecurity were examined using logistic and generalized logit regression models, respectively. Models included age, gender, racial-ethnic identity, and other sociodemographic characteristics associated with food insecurity to adjust for possible sample differences across waves. Models were weighted to reflect each country's population. RESULTS Adults [adjusted OR (AOR): 1.15; 95% CI: 1.02, 1.31] and youth (AOR: 1.43; 95% CI: 1.19, 1.71) in Mexico were more likely to live in food-insecure households in 2020 compared to 2019. Adults in Australia (AOR: 0.81; 95% CI: 0.72, 0.92) and Canada (AOR: 0.87; 95% CI: 0.77, 0.99) were less likely to live in food-insecure households in 2020. Trends in severity aligned with changes in prevalence, with some exceptions. Youth in Australia (AOR: 2.24; 95% CI: 1.65, 3.02) and the United States (AOR: 1.39; 95% CI: 1.04, 1.86) were more likely to have many compared with no experiences of food insecurity in 2020 compared to 2019. There was no evidence of change among adults and youth in the remaining countries. CONCLUSIONS Except for Mexico, few changes in food insecurity among adults and youth were observed from before to during the COVID-19 pandemic. Action is needed to support households at risk of food insecurity. J Nutr 20XX;xx:xx-xx.
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Affiliation(s)
- Alexandra Pepetone
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kevin W. Dodd
- Division of Cancer Prevention, NCI, Bethesda, MD, USA
| | - Michael P. Wallace
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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McRell AS, Fram MS, Frongillo EA. Adolescent-Reported Household Food Insecurity and Adolescents' Poor Mental and Physical Health and Food Insufficiency in Kenya. Curr Dev Nutr 2022; 6:nzac117. [PMID: 35957739 PMCID: PMC9362762 DOI: 10.1093/cdn/nzac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Assessing adolescents' experiences of food insecurity in households is important for promoting healthy development. Although parental reports have been traditionally used, emerging research highlights the importance of child and adolescent reports of the household food environment. Objectives Extending research from high- and upper-middle-income countries, this study of adolescent compared with adult reports of household food insecurity in Kenya, a lower-middle-income country, examined 1) prevalence of and correspondence between adolescent and adult reports of household food insecurity, and 2) associations of adolescent and adult reports of household food insecurity with adolescent nonnutritional and nutritional outcomes. Methods Using data from the Kenya Violence Against Children Surveys (n = 1182), we assessed prevalence of household food insecurity reported by adolescents (ages 13-17 y) and adults, with McNemar χ2 and κ analysis of correspondence between reports. Ordinal and binary logistic regression assessed associations between adolescent and adult reports and adolescent mental health and self-rated physical health and food sufficiency outcomes. Results Household food insecurity was reported by 36% of adolescents and 63% of adults; 36% of adult reports were discordant with adolescent reports (κ = 0.333). Odds of adolescent mental health difficulties were highest with adolescent-only report (OR = 2.11, P = 0.02), followed by adult and adolescent (OR = 1.83, P = 0.001) and adult-only (OR = 1.06, P = 0.77) report. Odds of poor adolescent self-rated physical health were highest with adult and adolescent report (OR = 2.47, P < 0.001) followed by adolescent-only (OR = 2.04, P = 0.08) and adult-only (OR = 1.37, P = 0.20) report. Odds of adolescents eating ≤1 meals the previous day were highest with adult and adolescent (OR = 21.38, P < 0.001) followed by adult-only (OR = 7.44, P = 0.01) and adolescent-only (OR = 2.31, P = 0.34) report. Conclusions Measuring household food insecurity with both adolescent report and adult report is important for having a comprehensive understanding of household resources and needs and of the nonnutritional (mental and physical health) and nutritional (diet and food) outcomes of household food insecurity for adolescents.
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Affiliation(s)
- Amanda S McRell
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Maryah S Fram
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Frongillo EA, Fram MS, Ghattas H, Bernal J, Jamaluddine Z, Kirkpatrick SI, Hammond D, Aurino E, Wolf S, Goudet SM, Nyawo M, Hayashi C. Development, Validity, and Cross-Context Equivalence of the Child Food Insecurity Experiences Scale for Assessing Food Insecurity of School-Age Children and Adolescents. J Nutr 2022; 152:2135-2144. [PMID: 35652807 PMCID: PMC9445849 DOI: 10.1093/jn/nxac127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children ages 6 to 17 years can accurately assess their own food insecurity, whereas parents are inaccurate reporters of their children's experiences of food insecurity. No globally applicable scale to assess the food insecurity of children has been developed and validated. OBJECTIVES We aimed to develop a globally applicable, experience-based measure of child and adolescent food insecurity and establish the validity and cross-contextual equivalence of the measure. METHODS The 10-item Child Food Insecurity Experiences Scale (CFIES) was based on items previously validated from questionnaires from the United States, Venezuela, and Lebanon. Cognitive interviews were conducted to check understanding of the items. The questionnaire then was administered in 15 surveys in 13 countries. Other items in each survey that assessed the household socioeconomic status, household food security, or child psychological functioning were selected as criterion variables to compare to the scores from the CFIES. To investigate accuracy (i.e., criterion validity), linear regression estimated the associations of the CFIES scores with the criterion variables. To investigate the cross-contextual equivalence (i.e., measurement invariance), the alignment method was used based on classical measurement theory. RESULTS Across the 15 surveys, the mean scale scores for the CFIES ranged from 1.65 to 5.86 (possible range of 0 to 20) and the Cronbach alpha ranged from 0.88 to 0.94. The variance explained by a 1-factor model ranged from 0.92 to 0.99. Accuracy was demonstrated by expected associations with criterion variables. The percentages of equivalent thresholds and loadings across the 15 surveys were 28.0 and 5.33, respectively, for a total percentage of nonequivalent thresholds and loadings of 16.7, well below the guideline of <25%. That is, 83.3% of thresholds and loadings were equivalent across these surveys. CONCLUSIONS The CFIES provides a globally applicable, valid, and cross-contextually equivalent measure of the experiences of food insecurity of school-aged children and adolescents, as reported by them.
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Affiliation(s)
| | - Maryah S Fram
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Hala Ghattas
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Jennifer Bernal
- Faculty of Nutrition and Food Sciences, CES University, Medellin, Colombia
| | - Zeina Jamaluddine
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Elisabetta Aurino
- Department of Economic History, Institutions, Policy and World Economy, Faculty of Economics, University of Barcelona, Spain
| | - Sharon Wolf
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - Sophie M Goudet
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Mara Nyawo
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
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Household and child food insecurity and CVD risk factors in lower-income adolescents aged 12-17 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. Public Health Nutr 2022; 25:922-929. [PMID: 34155968 PMCID: PMC9991548 DOI: 10.1017/s1368980021002652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Household food insecurity is associated with CVD risk factors in low-income adults, but research on these associations among adolescents is inconsistent. This study investigates whether household and child food insecurity is associated with CVD risk factors in lower-income adolescents. DESIGN Cross-sectional. Multivariable linear regression assessed the association between household and child food security and CVD risk factors. Household and child food security was measured using the US Food Security Survey Module. The analyses were adjusted for adolescent's age, sex, race/ethnicity, smoking status, physical activity and sedentary time, as well as household income and the head-of-household's education and marital status. SETTING The USA. PARTICIPANTS The sample was comprised of 2876 adolescents, aged 12-17 years, with household incomes at or below 300 % federal poverty line from the National Health and Nutrition Examination Survey cycles 2007-2016. RESULTS The weighted prevalence of household food insecurity in the analytic sample was 33·4 %, and the weighted prevalence of child food insecurity was 17·4 %. After multivariable adjustment, there were no significant associations between household and child food insecurity and BMI-for-age Z-score, systolic and diastolic blood pressure, HDL-cholesterol, total cholesterol, fasting TAG, fasting LDL-cholesterol and fasting plasma glucose. CONCLUSIONS Despite observed associations in adults, household food insecurity was not associated with CVD risk factors in a national sample of lower-income adolescents. Child food insecurity was also not associated with CVD risk factors. More research should be conducted to confirm these associations.
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Byker Shanks C, Calloway EE, Parks CA, Yaroch AL. Scaling up measurement to confront food insecurity in the USA. Transl Behav Med 2021; 10:1382-1389. [PMID: 33277900 DOI: 10.1093/tbm/ibaa112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
It is necessary to scale up measurement in order to confront the persisting problem of food insecurity in the United States (USA). The causes and consequences around food insecurity are briefly described in order to frame the complexity of the public health issue and demonstrate need for expanded measurement approaches. We assert that measurement of food security in the USA is currently based upon a core set of rigorous metrics and, moving forward, should also constitute a supplemental registry of measures to monitor and address variables that are associated with increased risk for food insecurity. Next, we depict dietary quality as a primary example of the power of measurement to make significant progress in our understanding and management of food insecurity. Finally, we discuss the translational implications in behavioral medicine required to make progress on achieving food security for all in the USA.
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Affiliation(s)
- Carmen Byker Shanks
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | | | | | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
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Young SL, Frongillo EA, Jamaluddine Z, Melgar-Quiñonez H, Pérez-Escamilla R, Ringler C, Rosinger AY. Perspective: The Importance of Water Security for Ensuring Food Security, Good Nutrition, and Well-being. Adv Nutr 2021; 12:1058-1073. [PMID: 33601407 PMCID: PMC8321834 DOI: 10.1093/advances/nmab003] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/21/2022] Open
Abstract
Water security is a powerful concept that is still in its early days in the field of nutrition. Given the prevalence and severity of water issues and the many interconnections between water and nutrition, we argue that water security deserves attention commensurate with its importance to human nutrition and health. To this end, we first give a brief introduction to water insecurity and discuss its conceptualization in terms of availability, access, use, and stability. We then lay out the empirical grounding for its assessment. Parallels to the food-security literature are drawn throughout, both because the concepts are analogous and food security is familiar to the nutrition community. Specifically, we review the evolution of scales to measure water and food security and compare select characteristics. We then review the burgeoning evidence for the causes and consequences of water insecurity and conclude with 4 recommendations: 1) collect more water-insecurity data (i.e., on prevalence, causes, consequences, and intervention impacts); 2) collect better data on water insecurity (i.e., measure it concurrently with food security and other nutritional indicators, measure intrahousehold variation, and establish baseline indicators of both water and nutrition before interventions are implemented); 3) consider food and water issues jointly in policy and practice (e.g., establish linkages and possibilities for joint interventions, recognize the environmental footprint of nutritional guidelines, strengthen the nutrition sensitivity of water-management practices, and use experience-based scales for improving governance and regulation across food and water systems); and 4) make findings easily available so that they can be used by the media, community organizations, and other scientists for advocacy and in governance (e.g., tracking progress towards development goals and holding implementers accountable). As recognition of the importance of water security grows, we hope that so too will the prioritization of water in nutrition research, funding, and policy.
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Affiliation(s)
- Sera L Young
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Zeina Jamaluddine
- London School of Tropical Medicine and Hygiene, London, England
- American University of Beirut, Lebanon, Beirut
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Claudia Ringler
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, USA
| | - Asher Y Rosinger
- Department of Biobehavioral Health and Department of Anthropology, Pennsylvania State University, State College, PA, USA
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Frongillo EA, Bernal J, Rampalli KK, Massey E, Adams EJ, Rosemond TN, Blake CE. Experiences and Situations of Shame among Food-insecure Adolescents in South Carolina and Oregon. Ecol Food Nutr 2021; 61:64-80. [PMID: 34319185 DOI: 10.1080/03670244.2021.1956484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Shame experienced with food insecurity and participating in food assistance may affect adolescents. We investigated adolescents' experiences of shame related to food insecurity and situations for these experiences in an ethnically diverse sample of 40 adolescents aged 9-15 years from South Carolina and Oregon. In-depth interviews were recorded, transcribed, coded, and analyzed. Participants described feelings of sadness, anger, and internalized shame with food insecurity. Salient situations were participating in food assistance, seeking food assistance from others or community services, and social encounters at school among peers. Adolescents felt shame knowing that peers were aware of their food insecurity and about them participating in food assistance through school.
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Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Colombia, USA
| | - Jennifer Bernal
- Faculty of Nutrition and Food, CES University, Medellin, Colombia, USA
| | - Krystal K Rampalli
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Colombia, USA
| | - Elizabeth Massey
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth J Adams
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Tiara N Rosemond
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Colombia, USA
| | - Christine E Blake
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Colombia, USA
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Household food insecurity and children's physical activity and sedentary behaviour in the United States: the Healthy Communities Study. Public Health Nutr 2021; 25:381-388. [PMID: 34108064 PMCID: PMC8660938 DOI: 10.1017/s1368980021002536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: To examine associations between household food insecurity and children’s physical activity and sedentary behaviours. Design: Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling. Setting: A total of 130 communities in the USA. Participants: In sum, 5138 US children aged 4–15 years. Results: No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03). Conclusions: Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.
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Hudak KM, Racine EF, Schulkind L. An Increase in SNAP Benefits Did Not Impact Food Security or Diet Quality in Youth. J Acad Nutr Diet 2020; 121:507-519.e12. [PMID: 33187930 DOI: 10.1016/j.jand.2020.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low diet quality during childhood and adolescence is associated with adverse health outcomes later in life. Diet quality is generally poor in American youth, particularly in youth of low socioeconomic status. The Supplemental Nutrition Assistance Program (SNAP) is the primary safety net to help low-income households afford a healthy diet. Yet self-selection into the program creates challenges in estimating the relationship between SNAP and diet outcomes. OBJECTIVE This study examined how the increase in SNAP benefits during the American Recovery and Reinvestment Act (ARRA) affected food security and diet quality in low-income youth. DESIGN This analysis used a difference-in-differences design and data from the National Health and Nutrition Examination Survey 2007-2008 to 2011-2012 waves. PARTICIPANTS/SETTING The sample included children and adolescents aged 2 to 18 years with household income ≤250% of the Federal Poverty Line. Food security and diet outcomes in SNAP-eligible youth (n = 2,797) were examined, with children in nearly SNAP-eligible households serving as a comparison group (n = 1,169). The diet quality analysis stratified the sample by age range. MAIN OUTCOME MEASURES The study assessed food security and 6 dietary outcomes: 2 nutrients (sodium and fiber), 3 food categories (fruit, vegetables, and sugar-sweetened beverages), and 1 measure of overall diet quality (Healthy Eating Index 2010). STATISTICAL ANALYSIS PERFORMED Logistic regression and linear regression were used to estimate the relationship between SNAP eligibility and child food security and diet. RESULTS In unadjusted analysis, approximately 64% of SNAP-eligible children were food secure before ARRA and 73% were food secure while ARRA was in effect. Using logistic regression in a difference-in-differences framework, the ARRA SNAP benefit increase was not significantly associated with food security (odds ratio 1.37, P = 0.43). Diet quality of SNAP-eligible children was low, scoring a 46 out of 100 on the Healthy Eating Index 2010. Measures of diet quality did not significantly change from the pre-ARRA period to the ARRA period; this did not differ by age range. CONCLUSIONS The increase in SNAP benefits during ARRA did not significantly impact food security or diet quality in low-income children and adolescents. Additional research to better understand how SNAP benefits impact dietary choice is warranted.
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Affiliation(s)
- Katelin M Hudak
- Public Policy Department, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC.
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC
| | - Lisa Schulkind
- Department of Economics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC
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Sheikh S, Iqbal R, Qureshi R, Azam I, Barolia R. Adolescent food insecurity in rural Sindh, Pakistan: a cross-sectional survey. BMC Nutr 2020; 6:17. [PMID: 32226631 PMCID: PMC7098077 DOI: 10.1186/s40795-020-00343-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background Food insecurity (FI) is alarmingly high in developing countries including Pakistan. A quarter of Pakistan’s population consists of adolescents yet there is no information on their experience of FI. FI at adolescent age have long term effect on mental and physical health hence we aimed to determine the prevalence of food insecurity (FI) among adolescents and compare it with household FI, and assess social determinants of adolescent FI. Methods A cross-sectional survey on 799 households with unmarried adolescents was conducted from September 2015 to June 2016 in three union councils of Hyderabad, Pakistan. Unmarried 10–19 years old girls and boys were interviewed regarding their FI status using Household Food Insecurity Assessment Scale (HFIAS). Household-level FI was also assessed by interviewing mothers of adolescents, and it was compared with adolescent’s FI. Association of adolescent’s FI with socio-demographic determinants was explored through Cox regression using STATA version 14.0. and prevalence ratios were estimated. Results FI was found among 52.4% of the adolescents compared to 39% of the households. Thirty percent of the adolescents were food insecure within the food secure households. Female adolescents were found to be less food insecure (Adjusted Prevalence Ratio (APR) 0.4 95% CI [0.3, 0.5]) compared to males. Social determinants like socioeconomic status (SES), crowding index or education of parents were not associated with adolescents’ FI. Conclusion Half of the adolescents were found to be food insecure which raises concerns regarding their health in the long run. Gender is an important social determinant of FI among adolescents which suggests an in-depth exploration of social dynamics of adolescent FI. We recommend the mixed-methods study to develop contextually relevant interventions to reduce FI among this group and improve their health status.
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Affiliation(s)
- Sana Sheikh
- 1Department of Obstetrics and Gynecology, Private wing 2nd floor, Aga Khan University, Stadium road, Karachi, 74800 Pakistan
| | - Romaina Iqbal
- 2Department of Community Health Sciences, Ibn-e-Ridwan building, Aga Khan University, Stadium road, Karachi, 74800 Pakistan
| | - Rahat Qureshi
- 2Department of Community Health Sciences, Ibn-e-Ridwan building, Aga Khan University, Stadium road, Karachi, 74800 Pakistan
| | - Iqbal Azam
- 2Department of Community Health Sciences, Ibn-e-Ridwan building, Aga Khan University, Stadium road, Karachi, 74800 Pakistan
| | - Rubina Barolia
- 3School of Nursing and Midwifery, Aga Khan University, Stadium road, Karachi, 74800 Pakistan
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