Are food insecurity's health impacts underestimated in the U.S. population? Marginal food security also predicts adverse health outcomes in young U.S. children and mothers

An evaluation of a 9th and 10th grade Native American virtual pilot: Utilizing a culturally responsive and Inclusive Science model

STEM pipeline programs that pair underrepresented youth with culturally responsive mentors have been shown to support students' science identity development, belonging, and persistence. Yet, most scholarship focuses on undergraduates and advanced high schoolers. Funded by the National Institute of Diabetes, Digestive and Kidney Disease, the STEP-UP Pilot recruited a cohort of 9th and 10th grade American Indian students to participate in a mentored introductory research experience. The Inclusive Science Framework provided the foundation for Pilot development and evaluation, with an emphasis on cultural responsivity and identity integration. American Indian mentors and mentees met virtually for six weeks with a curriculum that focused on building basic scientific research methodologies in the context of type 2 diabetes within Tribal communities. Our evaluation found that overall participation produced a positive impact for science interest, attitudes, and the translation of science into community.

Occurrence and predictors of food insecurity in a sample of pregnant women recruited from an Australian hospital

AIMS

The aim of this study is to explore the occurrence of food insecurity among pregnant women in Australia.

METHODS

This cross-sectional, self-reported study included two measures of food insecurity (the US Department of Agriculture Household Food Security Survey Module and single item measure), use of emergency and community food assistance, health conditions, eating habits during pregnancy, and professional nutritional advice and health seeking behaviours. Participants were recruited using (1) an advertisement posted on social media and (2) flyers with a QR code linked to the online survey, made available for women to take from clinic rooms at a hospital in Melbourne, Victoria. Data were analysed using basic statistics, spearman's rho correlation coefficients, and linear regression to identify factors that may be associated with food insecurity among pregnant women in Australia; the study was open between May 2021 and March 2022.

RESULTS

Three hundred and three valid responses were received from pregnant women in Australia. Food insecurity was determined to be 14.5% (US Department of Agriculture Household Food Security Survey Module) and 6.3% (single item used). Food insecurity was significantly associated with income, education level and age.

CONCLUSIONS

Results indicate a high prevalence of food insecurity among pregnant women. Routine screening and referral of food insecure pregnant women should be considered in antenatal care settings.

Low-Intensity Social Care and Child Acute Health Care Utilization: A Randomized Clinical Trial

Importance

Social care could be sustained with savings resulting from reduced acute health care utilization.

Objective

To evaluate the impact of CommunityRx, a low-intensity, high-scale social care assistance intervention.

Design, Setting, and Participants

This double-blind randomized clinical trial took place from November 2020 through August 2023 at an urban children's hospital with 12-month follow-up. Inclusion criteria were primary caregiver of a child younger than 18 years who was hospitalized in general, intensive care, or transplant units, living in 1 of 42 zip codes, and consenting to text messages. Caregivers of healthy newborns and children with expected hospitalization less than 24 hours or longer than 30 days were excluded.

Interventions

Participants were randomized to usual care (n = 320) or usual care plus CommunityRx (n = 320). Essential intervention components included education about common social conditions, personalized information about local resources, and ongoing navigator support with automated, proactive text messages (3 months) and ongoing availability for participant-initiated requests (12 months).

Main Outcomes and Measures

Preplanned analyses focused on food insecure (FI) subgroup outcomes (n = 223): self-efficacy for finding resources at 12 months (primary), caregiver-reported child health, and number of child emergency department (ED) and hospital admissions over 12 months. Regression models were fit with treatment group and baseline outcome characteristics. Odds ratios (ORs) or incidence rate ratios (IRRs) and 95% CIs were calculated. Post hoc analysis examined outcomes among the food secure (FS) subgroup (n = 414).

Results

Preplanned analyses included 223 FI participants and most identified as female (180 [95%]) and had household income less than $50 000 per year (197 [91%]). Self-efficacy at 12 months was similar among treatment groups (OR, 0.59; 95% CI, 0.25-1.39, P = .23). At 3 months, when automated navigator texts ended, 53 intervention group participants (69%) and 39 controls (45%) rated their child's health as excellent or very good (OR, 2.67; 95% CI, 1.14-6.24). During 12 months postdischarge, 54 FI children (41%) had 1 or more ED visits (median, 0; range, 0-32; intervention, 30%; control, 52%; IRR, 0.40; 95% CI, 0.21-0.76) and 32 had 1 or more hospitalizations (24%) (median, 0; range, 0-5; intervention, 15%; control, 34%; IRR, 0.48; 95% CI, 0.21-1.06). The intervention did not impact outcomes among FS caregivers.

Conclusions and Relevance

A low-intensity, high-scale social care assistance intervention beginning with pediatric hospitalization may be sustainable by reducing acute health care utilization, but did not increase caregiver self-efficacy for finding resources.

Trial Registration

ClinicalTrials.gov Identifier: NCT04171999.

Early Childhood Food Insecurity and Cardiovascular Health in Young Adulthood

Importance

Food insecurity is a social risk factor that may be associated with cardiovascular health across the life course.

Objective

To evaluate the association of food insecurity in early childhood with cardiovascular health (CVH) in young adulthood and whether associations are modified by participation during childhood in the Supplemental Nutrition Assistance Program (SNAP).

Design, Setting, and Participants

The Future of Families-Cardiovascular Health Among Young Adults cohort study was conducted in 20 US cities among 1071 individuals enrolled at birth (February 1998 to September 2000), evaluated in childhood (age, 3-5 years), and followed up to young adulthood (September 2021 to September 2023; mean [SD] participant age, 22.3 [0.7] years).

Main Outcomes and Measures

Household food insecurity (assessed by the US Department of Agriculture Food Insecurity survey) and SNAP participation at ages 3 to 5 years and CVH (assessed by the American Heart Association Life's Essential 8 [LE8] score, component LE8 scores, and clinical CVH risk factors).

Results

Of the 1071 participants, 570 were female (53%), 422 (39%) lived in households with food insecurity, and 475 (44%) participated in SNAP. Early childhood food insecurity was associated with having a lower LE8 score in young adulthood (β, -2.2 [95% CI, -4.0 to -0.4]). Among component LE8 scores and clinical CVH risk factors, food insecurity was associated with a lower LE8 score for body mass index (BMI; β, -4.9 [95% CI, -9.6 to -0.3]) and higher odds of having a BMI of 30 or more (adjusted odds ratio, 1.40 [95% CI, 1.07-1.84]). Food insecurity was more strongly associated with a lower LE8 score among those whose households did not participate in SNAP (β, -4.9 [95% CI, -7.6 to -2.3]) compared with those whose households participated in SNAP (β, 1.0 [95% CI, -1.6 to 3.7]).

Conclusions and Significance

This study suggests that early childhood food insecurity is associated with a higher BMI in young adulthood, which is associated with a worse overall LE8 score, especially among children whose families did not participate in SNAP. Policies to promote food security among children may promote healthy BMIs and better CVH across the life course.

Association between early-pandemic food assistance use and subsequent food security trajectories among households in Washington State during the first three years of the COVID-19 pandemic

BACKGROUND

Research on COVID-19's impact on food insecurity has primarily relied on cross-sectional data or long recall periods, with limited investigations into longitudinal patterns or the role of food assistance.

METHODS

We analyzed longitudinal data from 703 respondents participating in at least three Washington State Food Security Survey waves between June 18, 2020, and January 7, 2023. We assessed food security using the United States Department of Agriculture's six-item module, categorizing respondents' trajectories as persistently food secure, persistently food insecure, or experiencing one or more food insecurity transitions. We categorized food assistance use as never used, used before COVID-19 but not at baseline, did not use before COVID-19 but used at baseline, or always used. We descriptively examined sociodemographic factors linked to each food security trajectory and food assistance use pattern. We assessed associations between food assistance use and food security trajectories using modified Poisson regression.

RESULTS

We found that 20.2% of respondents were persistently food insecure, and 22.5% experienced one or more food insecurity transitions. Both patterns were more common among respondents who were aged 35 to 64, had a gender identity other than man or woman, were non-Hispanic Black, were single or divorced, had children, had some college education or less, reported $35,000 or less in household income, or were unemployed. In fully adjusted models, respondents who were newly using food assistance early in the COVID-19 pandemic had a higher probability of being persistently food insecure (marginal effect [ME] = 0.320, 95% CI = 0.204, 0.436) or experiencing one or more food insecurity transitions (ME = 0.216, 95% CI = 0.069, 0.363), than those who never used assistance.

CONCLUSIONS

Our findings highlight the importance of examining food security trajectories and food assistance use patterns and implementing policies that help households new to food assistance programs navigate these systems.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association of household food insecurity with diet quality in a nationally representative sample of United States toddlers: a cross-sectional study

BACKGROUND

Although previous research has shown that food insecurity adversely affects diet quality in adults, this relationship is less consistently observed in children. However, studies in children have focused on those aged 2 y or older and the association of food insecurity with diet quality in children aged 12-23 mo is unclear.

OBJECTIVES

The objective was to determine the association of household food insecurity with diet quality, as indicated by Healthy Eating Index-Toddlers-2020 (HEI-Toddlers-2020), in United States children aged 12-23 mo.

METHODS

The study used a cross-sectional design based on data from 2013-2014, 2015-2016, and 2017-March 2020 survey cycles of National Health and Nutrition Examination Survey. The primary sample included 708 children aged 12-23 mo with 1) complete data on food security, assessed via the United States Food Security Survey Module (USFSSM); 2) ≥1 d of reliable 24-h dietary recall data; and 3) reported energy intake from complementary foods/beverages (that is, foods and beverages other than human milk or infant formula). On the basis of responses to USFSSM, households were classified as food secure or food insecure. Proxies, typically parents, reported child's dietary intake. Diet quality was assessed using the HEI-Toddlers-2020. Linear regression analyses examined the association of household food security status with HEI-Toddlers-2020 total and component scores, adjusted for demographic characteristics.

RESULTS

Household food insecurity was significantly associated with lower HEI-Toddlers-2020 total score (estimate = -3.78; standard error = 1.06; P = 0.0007), as well as lower component scores for whole fruits (estimate = -0.56; standard error = 0.18; P = 0.003), and whole grains (estimate = -0.85; standard error = 0.35; P = 0.02).

CONCLUSIONS

The association of household food insecurity with lower diet quality in this study suggests that toddlers may not be shielded from household food shortages. Although consumption of certain food groups, such as whole grains, was inadequate in the overall sample of United States toddlers, food insecurity could exacerbate suboptimal intake of whole grains. Interventions to improve diet quality of young children must account for household food insecurity.

Food for Thought: The Impact of a Nutritional Toolkit on Well-being in Children

PURPOSE

This study investigated whether attendance by a cohort of pediatric patients at an educational/interventional nutritional program could impact dietary habits, physical health and mental well-being.

METHODS

A 16-week program was offered to 235 children with food insecurity which focused on fresh produce and nutritional education, recipes, as well as physical and mental wellness. Underlying diagnoses were obesity in 41.7 % (n = 98), cancer in 22.1 % (n = 52), mental health issues in 5.5 % (n = 12) or other in 30.7 % (n = 72). Health assessment surveys included changes in food choices, physical activity, mental wellness, memory, sleep, creativity, and BMI at enrollment, end of study, and at three-month follow-up. Results were compared by two-way student-t test and Pearson chi-square analysis.

RESULTS

The median age was 9.9 years (range 1-21 years). Significant improvements were found at the end of study in vegetable consumption (p = 0.002), physical activity (p = 0.001), mental wellness (p = 0.015), focus (p = 0.052), memory (p = 0.004), sleep (p = 0.003), creativity (p = 0.004) and BMI for obese patients (p = 0.025). Food choice improvements were seen in carbohydrates which decreased from 53.0 to 38.7 % (p = 0.013) and vegetable consumption which increased from 32.5 to 39.5 % (p = 0.014). Protein intake did not change significantly. At three-month follow-up there was no decline in interest, produce intake, physical activity, mental wellness, focus, sleep or creativity.

CONCLUSIONS

A diet intervention program where children and their parents are educated on healthy food choices had a significant influence on children's diet and well-being. For pediatric surgery patients with obesity and cancer, these changes could have a significant impact on long term outcomes and warrant further study.

LEVEL OF EVIDENCE

III.

Association between Unmet Social Need and Ambulatory Quality of Care for US Children

OBJECTIVES

Children who experience socioeconomic adversity often have worse health; however, less is known about their quality of care. We sought to evaluate the association between parent/caregiver-reported socioeconomic adversity and quality of pediatric primary, acute, and chronic ambulatory care on a national level.

METHODS

This was a retrospective cohort study of 5368 representative US children (1-17 years) in the 2021 Medical Expenditure Panel Survey. Socioeconomic adversity was defined as parent/caregiver-reported food, housing, transportation, or utility insecurity in the past 12 months. Outcomes included 10 quality measures of primary, acute, and chronic care, and experience of care measured through parent/caregiver survey. We described variation in socioeconomic adversity and used multivariable regression to examine associations with quality outcomes.

RESULTS

One-third of parent/caregivers reported socioeconomic adversity. Food insecurity (23.6%) was most common followed by utility (19.5%), housing (15.0%), and transportation (4.7%) insecurity. Black (53.2%) and Hispanic (46.9%) parent/caregivers experienced the highest rates of socioeconomic adversity. Children with socioeconomic adversity received lower quality of care for four quality measures, including more frequent Emergency Department visits (Odds Ratio (OR)= 1.69 [95% Confidence Interval (CI): 1.28-2.23]), less favorable asthma medication ratio (OR=0.04 [95% CI: 0.01-0.31]), and less frequent well child (OR=0.73 [95% CI: 0.59-0.90]) and dental care (OR=0.76 [95% CI: 0.63-0.94], P < .05 for all). There were no statistically significant differences in experience of care.

CONCLUSIONS

Socioeconomic adversity is common among US children with disproportionate impact on Black and Hispanic families. There are significant disparities in pediatric primary, acute, and chronic care quality, based on parent/caregiver-reported socioeconomic adversity, highlighting the need for systems-level interventions.

Association Between Food Insecurity and Inability to Obtain Provider-Recommended Medications, Multidisciplinary Services, and Technology in Youth and Young Adults With Diabetes: A Cross-Sectional Study

OBJECTIVE

We assessed if food insecurity (FI) is associated with not obtaining recommended diabetes medications, technology, and multidisciplinary services, and explored the most common reasons for not obtaining recommended treatments in youth and young adults (YYA) with diabetes.

METHODS

In this cross-sectional study, among 911 YYA with type 1 diabetes (T1D) and 144 with type 2 diabetes (T2D) from the SEARCH Food Security Cohort Study Follow-up 1 (2018-2021), FI (≥ 3 items affirmed from the 18-item Household Food Security Survey module), and inability to obtain recommended treatments were self-reported.

RESULTS

Almost 30% of YYA with T1D and FI and 20% of YYA with T2D and FI did not obtain 1 or more recommended treatments. Participants with T1D who reported FI had higher odds of not obtaining insulin (OR 3.2, 95% CI 1.2-8.4), mental health counseling (OR 3.3, 95% CI 1.3-8.2), diabetes education (OR 3.6, 95% CI 1.4-9.3), an insulin pump (OR 2.2, 95% CI 1.2-4.4), and a continuous glucose monitor (OR 2.5, 95% CI 1.5-4.4) compared to those who reported food security. Among participants with T2D, FI was related to not obtaining dietician services (OR 8.1, 95% CI 1.2-53.8). Participants with T1D and FI reported more financial reasons for not obtaining a continuous glucose monitor compared to food secure participants.

CONCLUSION

YYA with diabetes and FI face constraints in obtaining medications, diabetes technology, and multidisciplinary services, largely due to financial and structural reasons. New strategies are needed to bridge the gap between medical care required vs obtained by YYA with diabetes.

Climate variability, population growth, and globalization impacting food security in Pakistan

Global hunger has increased recently, returning to levels observed a decade ago. Climate change is identified as a key factor contributing to these increases and is a significant cause of severe food crises. When combined with population growth and globalization, future climate variability is expected to significantly affect global food security. This study examined the influence of climate variability, globalization, and population growth on food security (FS) in Pakistan from 1995 to 2023. Food security data was sourced from the Food and Agricultural Organization, and globalization data was obtained from the KOF Globalization Index. Datasets on climate variability, population growth, unemployment, and inflation were collected from the World Development Indicators. A two-layer principal component analysis was utilized to develop the food security index. Multivariate Generalized Auto-Regressive Conditional Heteroscedasticity was used to assess the impact of globalization, population growth, and climate variability on food security. All indexed components explained more than 50% of the variance, resulting in a food security eigenvalue of 3.603 with a 0.901 proportion. The findings indicated that population growth and climate variability significantly negatively affect Pakistan's food security. Furthermore, the study found that globalization notably mitigates the adverse effects of climate variability and population growth on food security. This research may help alleviate the risk of future undernourishment, reverse current trends of escalating food insecurity, and support the sustainable development goal of eliminating global hunger by 2030.

Reassessing the Burden of Food Insecurity in Youth and Young Adults With Youth-onset Diabetes: The Importance of Marginal Food Security

INTRODUCTION

Whereas marginal food insecurity (FI) has been recognized as important in Canadian food security policy, the category of marginal food security (MFS) is often ignored in US food security research.

METHODS

Prevalence of FI was estimated according to the conventional and an alternate classification of MFS with FI among 938 youth and young adults (YYA) with youth-onset type 1 diabetes (T1D) and 156 with youth-onset type 2 diabetes (T2D) from the SEARCH Food Security Cohort Study (2018-2021). Multivariable regression was used to estimate the association of MFS and conventionally defined FI ascertained with diabetes-related outcomes, including acute diabetes complications, health-care utilization, and diabetes self-management among YYA with T1D.

RESULTS

MFS affected 10% of participants with T1D and 20% of participants with T2D. Classifying MFS with FI increased FI prevalence from 18.0% to 27.8% in participants with T1D and 34.6% to 55.1% in participants with T2D. Compared to T1D with high food security, YYA with T1D who were experiencing FI had higher odds of hypoglycemia (2.1, 95% confidence interval [CI] 1.2 to 3.6) and ketoacidosis (1.6, 95% CI 1.0 to 2.6), but no association was seen in MFS. The FI group also had higher odds of emergency department use and hospitalization (2.3, 95% CI 1.5 to 3.4; 2.4, 95% CI 1.5 to 3.9) and lower odds of technology use and checking glucose (0.6, 95% CI 0.4 to 0.9; 0.3, 95% CI 0.1 to 0.6). The MFS group exhibited associations of similar directions.

CONCLUSION

Health-care providers should consider care of individuals with T1D and MFS in the same way as care for those with FI.

Caregivers' Views of a Pediatric Inpatient Intervention to Address Health-Related Social Risks

OBJECTIVE

To understand the experiences of parents and caregivers of hospitalized children with CommunityRx-Hunger, a social care intervention designed to address food insecurity and other health-related social risks (HRSRs). Perspectives on how clinicians can sensitively deliver information about HRSRs in the pediatric inpatient setting were also elicited.

METHODS

In-depth, semistructured qualitative interviews were conducted (April 2022 through April 2023) with caregivers of children hospitalized at an urban academic medical center. Caregivers (N = 23) were purposefully sampled from the intervention arm of the double-blind CommunityRx-Hunger randomized controlled trial (NCT4171999). Initiated during hospital discharge, CommunityRx-Hunger includes 3 evidence-based components: education about HRSRs, delivery of HRSR-related resource information, and ongoing support to boost the intervention over 12 months. Data were analyzed using directed content analysis.

RESULTS

Most caregivers identified as the child's mother (n = 20) and as African American or Black (n = 19) and were partnered (n = 14). Three main themes emerged: (1) positive experiences with CommunityRx-Hunger, including the sentiment that caregivers were unaware of the amount of community resources available to address HRSRs and perceptions that caregivers "were set up for success once we left the hospital"; (2) barriers to integrating social care with medical care, including concern that clinicians "are gonna use [disclosure of HRSRs] against me"; and (3) recommendations for optimizing social care delivery, including a prevalent suggestion to "just give the information" to caregivers, without asking about risks or needs.

CONCLUSION

CommunityRx-Hunger was mostly well received by caregivers. Routinely providing resource information to all caregivers of hospitalized children, regardless of need, could help alleviate concerns about disclosing HRSRs.

Food Acquisition Coping Strategies Vary Based on Food Security Among University Students

Background

Food insecurity on college campuses is a pressing issue, yet the ways in which students manage challenges and disruptions to their food security status (FSS) are poorly understood.

Objectives

The objective of this study was to examine knowledge of food insecurity as a concept, evaluate FSS, identify food acquisition-related behaviors, and determine whether these behaviors differ among FSS.

Methods

University students at increased risk of experiencing food insecurity (n = 43) were recruited for this mixed-methods study. Participants were surveyed about their FSS, coping strategies, and use of food access resources. Subsequent interviews occurred to evaluate their understanding of food insecurity as a concept and related food acquisition behaviors. The total number of coping strategies and food access resources used were quantified, and composite variables were created. Differences based on FSS classification were examined through regression analyses. Quantitative and qualitative data were integrated using concurrent triangulation.

Results

Despite targeted recruitment efforts, 76% of participants were classified as food secure by the United States Department of Agriculture (USDA) Adult Food Security Survey Module (AFSSM). Participants were able to define food insecurity and identify circumstances that could contribute to an individual becoming food insecure. However, many participants described experiences that suggested the USDA AFSSM may not accurately capture students' true FSS. Most individuals faced significant challenges in maintaining food security. Participants used a series of coping strategies and food access resources to maintain or improve their food security, regardless of FSS, which included couponing, strategizing when food was low, and sharing food with housemates. Additionally, participants expressed concerns that their use of food access resources may deprive others with greater need.

Conclusions

Results from this study shed insight on the complexities of food insecurity in the university setting, providing useful data to inform the development of better programs, outreach, and evaluation tools that encapsulate the many unique factors that make up FSS for students.

Food Insecurity and Weight Faltering: US Multisite Analysis of Young Children's Weight Trajectory

BACKGROUND

Food insecurity is associated with poor health and development among young children, with inconsistent findings related to longitudinal growth.

OBJECTIVE

The aim of this study was to investigate associations between household and child food insecurity and young children's weight trajectory during ages 0 to 2 years.

DESIGN

Longitudinal survey data were analyzed for years 2009 to 2018.

PARTICIPANTS/SETTING

Racially diverse mothers of 814 children ≤24 months interviewed twice (interval >6 months, mean 11 months) in emergency departments of 4 US cities. Children were included if born at term, with birth weight within 2500 to 4500 g, and weight-for-age z score within ±2 SD at first interview.

MAIN OUTCOME MEASURES

Weight-for-age z score difference between 2 visits was defined as "expected weight gain" (within ±1.34 SD), "slow weight gain" (< -1.34 SD), or "rapid weight gain" (> +1.34 SD).

STATISTICAL ANALYSES PERFORMED

Multinomial logistic regression was conducted to examine adjusted associations between household or child food insecurity and weight-for-age z score differences.

RESULTS

Of 814 children, 83.5% had expected weight gain, 7% had slow weight gain, and 9.5% had rapid weight gain, with mean ± SD of 11 ± 4 months between visits. Child food insecurity, but not household food insecurity, was associated with slow weight gain (adjusted relative risk ratio 2.44; 95% CI 1.16 to 5.13 and adjusted relative risk ratio 1.30; 95% CI 0.69 to 2.51, respectively). Neither exposure was associated with rapid weight gain.

CONCLUSIONS

The association between child food insecurity and slow weight gain during the first 2 years of life raises clinical concern. Tracking child food insecurity in addition to household food insecurity can be an effective strategy to prevent weight faltering and to support optimal child growth.

Addressing food insecurity in the inpatient setting: Results of a postdischarge pilot study

BACKGROUND AND OBJECTIVES

With a growing interest in screening for food insecurity (FI) during pediatric hospitalization, there is a parallel need to develop interventions. With input from caregivers experiencing FI, we sought to identify interventions to assist with short-term FI after discharge and evaluate their feasibility, acceptability, and appropriateness.

METHODS

We first employed qualitative methods to identify potential interventions. Next, we conducted a pilot study of selected interventions for families experiencing FI. Seven days postdischarge, caregivers rated the intervention's feasibility, acceptability, and appropriateness. We also assessed for ongoing FI. We summarized the median and proportion of "completely agree" responses to feasibility, acceptability, and appropriateness questions, and we compared in-hospital and postdischarge FI using McNemar's test.

RESULTS

In the qualitative stage, 14 caregivers prioritized three interventions: grocery store gift cards, grocery delivery/pick-up, and frozen meals. In the pilot study, 53 caregivers (25% of those screened) endorsed FI during their child's hospitalization and received one or more of the interventions. Every caregiver selected the grocery gift card option; 37 families (69.8%) also received frozen meals. Seven days after discharge, most caregivers rated the intervention as "completely" feasible (76%), acceptable (90%), and appropriate (88%). There was a significant decrease in caregivers who reported FI after discharge compared to during the hospitalization (p < .001).

CONCLUSIONS

This study demonstrates the feasibility, acceptability, and appropriateness of inpatient interventions to address FI, particularly at the time of pediatric hospital discharge and transition home. Randomized trials are needed to further evaluate the efficacy of interventions employed during hospitalization.

Food Insecurity and Dementia Risk in U.S. Older Adults: Evidence From the 2013-2021 Panel Study of Income Dynamics

OBJECTIVES

Growing research suggests that food insecurity is associated with worse cognitive functioning; however, prospective studies are needed to examine food insecurity and dementia risk. Using longitudinal and nationally representative data, we examined the effects of food insecurity on dementia risk among older adults.

METHODS

Data were from 3,232 adults (≥65 years) from the Panel Study of Income Dynamics. Food insecurity was assessed biennially using the U.S. Household Food Security Survey Module from 2015 to 2019. Probable dementia risk was assessed biennially using the Eight-Item Interview to Differentiate Aging and Dementia from 2017 to 2021. Inverse probability weighting and marginal structural models were used to account for the time-varying nature of food insecurity and sociodemographic and health confounders.

RESULTS

After accounting for baseline and time-varying sociodemographic and health covariates, there was a 2-fold higher association between food insecurity and probable dementia risk (odds ratio 2.11, 95% confidence interval: 1.12-3.98). The results were robust to expanding the exposure to include marginal food security and the outcome to include informant-reported memory loss. Furthermore, there was no evidence of heterogeneity in the association of food insecurity and probable dementia risk by sex, race, and ethnicity, or participation in the Supplemental Nutrition Assistance program.

DISCUSSION

Food insecurity is a modifiable social determinant of health. Interventions and policies are needed to reduce food insecurity and promote healthy aging for older adults.

The Association Between Food Insecurity, Parental Stress, and Child Development

BACKGROUND AND OBJECTIVES

It is recognized that development in the 0-to-5-year period is predictive of lifelong health and well-being and that early childhood development is influenced by parental mental health. Social stressors such as food insecurity can exacerbate parental mental health issues.

METHODS

To improve understanding of this complex interplay, a primary care pediatric practice designed an innovative meal and grocery delivery program for families experiencing food insecurity with at least one child aged 0-5 years. As part of the program, food insecurity, parental mental health, and child development were assessed.

RESULTS

Food insecurity was found to be correlated with increased stress in the parent-child system, and increased stress was found to be strongly correlated with delays in early childhood developmental progress.

CONCLUSIONS

These findings suggest that changes in the parent-child relationship resulting from increased parental stress due to food insecurity can play a role in influencing early childhood development.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Associations between food insecurity in high-income countries and pregnancy outcomes: A systematic review and meta-analysis

BACKGROUND

Maternal nutrition is crucial for health in pregnancy and across the generations. Experiencing food insecurity during pregnancy is a driver of inequalities in maternal diet with potential maternal and infant health consequences. This systematic review explored associations between food insecurity in pregnancy and maternal and infant health outcomes.

METHODS AND FINDINGS

Searches included 8 databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and CINAHL), grey literature, forwards and backwards citation chaining, and contacting authors. Studies in high-income countries (HICs) reporting data on food insecurity in pregnancy and maternal or infant health, from January 1, 2008 to November 21, 2023 were included. Screening, data extraction, and quality assessment were carried out independently in duplicate. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. The protocol was registered on PROSPERO (CRD42022311669), reported with PRISMA checklist (S1 File). Searches identified 24,223 results and 25 studies (n = 93,871 women) were included: 23 from North America and 2 from Europe. Meta-analysis showed that food insecurity was associated with high stress level (OR 4.07, 95% CI [1.22, 13.55], I2 96.40%), mood disorder (OR 2.53, 95% CI [1.46, 4.39], I2 55.62%), gestational diabetes (OR 1.64, 95% CI [1.37, 1.95], I2 0.00%), but not cesarean delivery (OR 1.42, 95% CI [0.78, 2.60], I2 56.35%), birth weight (MD -58.26 g, 95% CI [-128.02, 11.50], I2 38.41%), small-for-gestational-age (OR 1.20, 95%, CI [0.88, 1.63], I2 44.66%), large-for-gestational-age (OR 0.88, 95% CI [0.70, 1.12] I2 11.93%), preterm delivery (OR 1.18, 95% CI [0.98, 1.42], I2 0.00%), or neonatal intensive care (OR 2.01, 95% CI [0.85, 4.78], I2 70.48%). Narrative synthesis showed food insecurity was significantly associated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. There were no significant associations with other organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for preeclampsia, hypertension, and community/resilience measures.

CONCLUSIONS

Maternal food insecurity is associated with some adverse pregnancy outcomes, particularly mental health and gestational diabetes. Most included studies were conducted in North America, primarily the United States of America, highlighting a research gap across other contexts. Further research in other HICs is needed to understand these associations within varied contexts, such as those without embedded interventions in place, to help inform policy and care requirements.

What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it is telling us

Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called 'cost of living crisis'. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.

Translational science approaches for food insecurity research

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

Factors associated with food insecurity among pregnant women in Gedeo zone public hospitals, Southern Ethiopia

Background

Food insecurity refers to a lack of consistent access to sufficient food for active, better health. Around two billion people worldwide suffer from food insecurity and hidden hunger. This study focuses on food insecurity and associated factors among pregnant women in Gedeo Zone Public Hospitals, Southern Ethiopia.

Method

An institutional-based cross-sectional study was conducted among pregnant women in Gedeo zone public hospitals from May to June 2021. Primary data of 506 pregnant women were collected using interviewer-administered structured questionnaire and a multi-stage sampling technique was used to select study participants. The household food insecurity access scale of the questionnaire was used and a woman was considered as food insecure when it has any of the food insecurity conditions mild, moderate, or severe food insecure, otherwise, it was classified as food secure. Adjusted odds ratio (AOR) and their 95% confidence intervals (CI) determined the association between various factors and outcomes.

Results

Of all study participants, 67.39% of the women were food insecure, and the remaining 32.6% had food security. The pregnant women from rural areas [AOR = 0.532, 95% CI: 0.285, 0.994], married [AOR = 0.232, 95% CI: 0.072, 0.750], had a secondary education [AOR = 0.356, 95%CI: 0.154, 0.822], and be employed [AOR = 0.453, 95% CI: 0.236, 0.872], the wealth index middle [AOR = 0.441, 95% CI: 0.246, 0.793] and rich [AOR = 0.24, 95% CI: 0.128, 0.449] were factors associated with food insecurity.

Conclusion

The study area had a high prevalence of food insecurity. Food insecurity was reduced in those who lived in rural areas, were married, had a secondary education, were employed, and had a wealth index of middle and rich.

Food insecurity among female collegiate athletes exists despite university assistance

OBJECTIVE

To determine the prevalence and characteristics of food insecurity among female collegiate athletes.

PARTICIPANTS

NCAA Division I female athletes attending a public university located in East Texas in 2018.

METHODS

A prospective cross-sectional online survey was employed to gather quantitative and qualitative data regarding food security status. Participants were instructed to complete the 26-item questionnaire, including the six-item USFSSM.

RESULTS

Participants (N = 78) were 18-22 years of age, largely white (75%). Despite most (89.74%) receiving some form of scholarship and 80% reporting provision of some meals, 32.10% were classified as food insecure. Barriers to food intake were two-fold higher among the food insecure (88% vs 43%, p < .001); limited time (43.6%) and finances (23.1%) were the most frequently reported barriers.

CONCLUSIONS

Despite university support, food insecurity exists in female collegiate athletes. Outcomes warrant screening for food insecurity, referral to support resources throughout matriculation, and tailored intervention programs.

Prevalence and Predictors of Food Insecurity among Adults with Type 1 Diabetes: Observational Findings from the 2022 Behavioral Risk Factor Surveillance System

The majority of data on food insecurity in diabetes comes from samples of type 2 diabetes or youth with type 1 diabetes. This study screened for food insecurity among adults with type 1 diabetes in the 2022 Behavioral Risk Factor Surveillance Survey, which was the first year that respondents who endorsed diabetes were asked to indicate whether they had type 1 or type 2. One validated screening item asked, "During the past 12 months, how often did the food that you bought not last and you didn't have money to buy more?". Respondents who answered "always", "usually", "sometimes", or "rarely" were categorized as having a positive screen for food insecurity. Seventy-six percent of the sample was white/non-Hispanic. Over one-quarter screened positive for food insecurity. This prevalence is higher than some reports of food insecurity in type 1 diabetes but consistent with reports that include 'marginal' food security in the count of food-insecure individuals. White/non-Hispanics had a lower risk of a positive screen than minoritized respondents. Respondents reporting older age, lower educational attainment, not working, lower income, and receiving SNAP benefits had higher rates of a positive screen. Significant healthcare factors associated with a positive screen were receiving government insurance instead of private, not being able to afford to see a doctor, and worse general, physical, and mental health. In conclusion, rates of a positive screen for food insecurity among people with type 1 diabetes in this study were alarmingly high and associated with other socioeconomic indicators. Screening for food insecurity with appropriate instruments for samples with type 1 diabetes, across the U.S. and internationally, should be a priority.

Food Insecurity and Community-Based Food Resources Among Caregivers of Hospitalized Children

OBJECTIVE

Children's hospitals are implementing interventions to connect families to community-based resources. This study describes food insecurity (FI) and food resource knowledge, need, and use among families with a hospitalized child.

METHODS

Between November 2020 and June 2022, 637 caregivers of hospitalized children in an urban 42-ZIP-code area were surveyed as part of a randomized controlled trial. The United States Department of Agriculture 18-item Household Food Security Survey was used to evaluate 12-month food security (food secure [score of 0=FS]; marginally secure [1-2=MFS]; insecure [3-18=FI]). Food resource knowledge, need, and use were described by food security status and examined using Cochran-Armitage tests. The distribution of local resources was obtained from a database and mapped by ZIP code.

RESULTS

Comparing FI (35.0%) with MFS (17.6%) and FS (47.4%) groups, the rates of resource knowledge were lower (70.2% vs 78.5%, 80.5%), and the rates of need (55.1% vs 30.6%, 14.2%) and use (55.3% vs 51.4%, 40.8%) were higher. Rates of food resource knowledge increased linearly with increasing food security (FI to MFS to FS; P = .008), whereas the rates of resource need (P < .001) and use (P = .001) decreased with increasing food security. There were 311 community-based organizations across 36 ZIP codes with participants (range/ZIP code = 0-20, median = 8).

CONCLUSIONS

Half of families with a hospitalized child experienced FI or MFS. Although families exhibited high food resource knowledge, nearly half of families with FI had unmet food needs or had never used resources.

Predictors of persistent moderate and severe food insecurity in a longitudinal survey in Mexico during the COVID-19 pandemic

Background

Household food insecurity (HFI) increased in Latin America by 9% between 2019 and 2020. Scant evidence shows who was unable to recover from the COVID-19 pandemic. Our aim was to use a Machine Learning (ML) approach to identify consistent and influential predictors of persistent moderate or severe HFI over 2 years.

Methods

We use a three-wave longitudinal telephone survey with a probabilistic sample representative of the Mexican population. With a response rate of 51.3 and 60.8% for the second and third waves, the final sample size consisted of 1,074 individuals. The primary outcome was persistent HFI, i.e., respondents who reported moderate or severe HFI in 2021 and 2022. Twelve income-related predictors were measured in 2020, including baseline HFI. We employed 6 supervised ML algorithms to cross-validate findings in models, examined its precision with 4 standard performance indicators to assess precision, and used SHAP values (Shapley Additive exPlanations) to identify influential predictors in each model.

Results

Prevalence of persistent moderate/severe HFI in 2021 and 2022 was 8.8%. Models with only a HFI 2020 baseline measure were used as a reference for comparisons; they had an accuracy of 0.79, a Cohen's Kappa of 0.57, a sensitivity of 0.68, and a specificity of 0.88. When HFI was substituted by the suite of socioeconomic indicators, accuracy ranged from 0.70 to 0.84, Cohen's Kappa from 0.40 to 0.67, sensitivity from 0.86 to 0.90, and specificity from 0.75 to 0.82. The best performing models included baseline HFI and socioeconomic indicators; they had an accuracy between 0.81 and 0.92, a Cohen's Kappa between 0.61 and 0.85, a sensitivity from 0.74 to 0.95, and a specificity from 0.85 to 0.92. Influential and consistent predictors across the algorithms were baseline HFI, socioeconomic status (SES), adoption of financial coping strategies, and receiving government support.

Discussion

Persistent HFI can be a relevant indicator to identify households that are less responsive to food security policies. These households should be prioritized for innovative government support and monitored to assess changes. Forecasting systems of HFI can be improved with longitudinal designs including baseline measures of HFI and socioeconomic predictors.

Prediabetes Prevalence by Adverse Social Determinants of Health in Adolescents

Importance

Several clinical practice guidelines advise race- and ethnicity-based screening for youth-onset type 2 diabetes (T2D) due to a higher prevalence among American Indian and Alaska Native, Asian, Black, and Hispanic youths compared with White youths. However, rather than a biological risk, this disparity likely reflects the inequitable distribution of adverse social determinants of health (SDOH), a product of interpersonal and structural racism.

Objective

To evaluate prediabetes prevalence by presence or absence of adverse SDOH in adolescents eligible for T2D screening based on weight status.

Design, Setting, and Participants

This cross-sectional study and analysis used data from the 2011 to 2018 cycles of the National Health and Nutrition Examination Survey. Data were analyzed from June 1, 2023, to April 5, 2024. Participants included youths aged 12 to 18 years with body mass index (BMI) at or above the 85th percentile without known diabetes.

Main Outcomes and Measures

The main outcome consisted of an elevated hemoglobin A1c (HbA1c) level greater than or equal to 5.7% (prediabetes or undiagnosed presumed T2D). Independent variables included race, ethnicity, and adverse SDOH (food insecurity, nonprivate health insurance, and household income <130% of federal poverty level). Survey-weighted logistic regression was used to adjust for confounders of age, sex, and BMI z score and to determine adjusted marginal prediabetes prevalence by race, ethnicity, and adverse SDOH.

Results

The sample included 1563 individuals representing 10 178 400 US youths aged 12 to 18 years (mean age, 15.5 [95% CI, 15.3-15.6] years; 50.5% [95% CI, 47.1%-53.9%] female; Asian, 3.0% [95% CI, 2.2%-3.9%]; Black, 14.9% [95% CI, 11.6%-19.1%]; Mexican American, 18.8% [95% CI, 15.4%-22.9%]; Other Hispanic, 8.1% [95% CI, 6.5%-10.1%]; White, 49.1% [95% CI, 43.2%-55.0%]; and >1 or other race, 6.1% [95% CI, 4.6%-8.0%]). Food insecurity (4.1% [95% CI, 0.7%-7.5%]), public insurance (5.3% [95% CI, 1.6%-9.1%]), and low income (5.7% [95% CI, 3.0%-8.3%]) were each independently associated with higher prediabetes prevalence after adjustment for race, ethnicity, and BMI z score. While Asian, Black, and Hispanic youths had higher prediabetes prevalence overall, increasing number of adverse SDOH was associated with higher prevalence among White youths (8.3% [95% CI, 4.9%-11.8%] for 3 vs 0.6% [95% CI, -0.7% to 2.0%] for 0 adverse SDOH).

Conclusions and Relevance

Adverse SDOH were associated with higher prediabetes prevalence, across and within racial and ethnic categories. Consideration of adverse SDOH may offer a more actionable alternative to race- and ethnicity-based screening to evaluate T2D risk in youth.

Food Insecurity Screening in High-Income Countries, Tool Validity, and Implementation: A Scoping Review

Household food insecurity has significant negative implications across the lifespan. While routine screening is recommended, particularly in healthcare, guidelines are lacking on selection of screening tools and best-practice implementation across different contexts in non-stigmatizing ways. The objective of this scoping review was to synthesize evidence on household food insecurity screening tools, including psychometrics, implementation in a range of settings, and experiences of carrying out screening or being screened. Four electronic databases were searched for studies in English published from 1990 until June 2023. A total of 58 papers were included, 21 of which focused on tool development and validation, and 37 papers described implementation and perceptions of screening. Most papers were from the USA and described screening in healthcare settings. There was a lack of evidence regarding screening in settings utilized by Indigenous people. The two-item Hunger Vital Sign emerged as the most used and most valid tool across settings. While there is minimal discomfort associated with screening, screening rates in practice are still low. Barriers and facilitators of screening were identified at the setting, system, provider, and recipient level and were mapped onto the COM-B model of behavior change. This review identifies practical strategies to optimize screening and disclosure.

Associations between the social environment and early childhood developmental outcomes of Puerto Rican children with prenatal Zika virus exposure: a cross-sectional study

BACKGROUND

Prenatal exposure to the Zika virus can lead to microcephaly and adverse developmental outcomes, even in children without evident birth defects. The social environment plays a crucial role in infant health and developmental trajectories, especially during periods of heightened brain plasticity. The study aimed to assess socioenvironmental factors as predictors of developmental outcomes of 36-month-old children exposed to Zika virus prenatally.

STUDY DESIGN

This cross-sectional study included 53 mothers and 55 children enrolled in the Pediatric Outcomes of Prenatal Zika Exposure cohort study in Puerto Rico. The study performs follow-up developmental assessments of children born to mothers with confirmed and probable Zika virus infection during pregnancy. Mothers completed socioenvironmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey). Children's developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development: Third Edition, the Ages and Stages Questionnaires: Third Edition, the Ages and Stages Questionnaire-Socioemotional: Second Edition, and the Child Adjustment and Parent Efficacy Scale.

RESULTS

Linear regression models, adjusting for a child's sex and age and maternal education, revealed that early life exposure to food insecurity and maternal pregnancy stressors were significantly associated with poorer developmental outcomes in Zika virus-exposed children at 36 months of age. Maternal resilience representation of adaptive ability was associated with the preservation of adequate developmental outcomes in children.

CONCLUSIONS

Pregnancy and early childhood are critical life periods for ensuring optimal brain development in children. While the mechanisms in the interaction of children with their environment are complex, the risk and protective factors identified in the study are modifiable through public policy and preventive initiatives. Implementation of comprehensive strategies that improve access to social support programs, educational and nutritional interventions, and mental health services during pregnancy and early childhood can enhance the developmental potential of vulnerable children.

Food Insecurity Is Associated with Diet Quality in Pregnancy: A Cross-Sectional Study

Household food insecurity (HFI) and poorer prenatal diet quality are both associated with adverse perinatal outcomes. However, research assessing the relationship between HFI and diet quality in pregnancy is limited. A cross-sectional online survey was conducted to examine the relationship between HFI and diet quality among 1540 pregnant women in Australia. Multiple linear regression models were used to examine the associations between HFI severity (marginal, low, and very low food security compared to high food security) and diet quality and variety, adjusting for age, education, equivalised household income, and relationship status. Logistic regression models were used to assess the associations between HFI and the odds of meeting fruit and vegetable recommendations, adjusting for education. Marginal, low, and very low food security were associated with poorer prenatal diet quality (adj β = -1.9, -3.6, and -5.3, respectively; p < 0.05), and very low food security was associated with a lower dietary variety (adj β = -0.5, p < 0.001). An association was also observed between HFI and lower odds of meeting fruit (adjusted odds ratio [AOR]: 0.61, 95% CI: 0.49-0.76, p < 0.001) and vegetable (AOR: 0.40, 95% CI: 0.19-0.84, p = 0.016) recommendations. Future research should seek to understand what policy and service system changes are required to reduce diet-related disparities in pregnancy.

Racial discrimination is associated with food insecurity, stress, and worse physical health among college students

BACKGROUND

Students of color disproportionately experience racial discrimination and food insecurity, which both lead to poor academic and health outcomes. This study explores the extent to which the location of racial discrimination experienced is associated with food insecurity, stress, physical health and grade point average among college students METHODS: A cross sectional study design was implemented to survey 143 students from a racially diverse public university. Logistic regression models assessed if discrimination at various locations was associated with food insecurity and linear models assessed how racial discrimination was associated with physical health, stress and grade point average RESULTS: Student's experiencing food security had an average discrimination score of 2.3 (1.23, 3.37), while those experiencing food insecurity had a statistically significant (P < 0.001) higher average discrimination score 7.3 (5.4, 9.21). Experiencing any racial discrimination was associated with increased odds of experiencing food insecurity when experienced from the police (OR 11.76, 95% CI: 1.41, 97.86), in the housing process (OR 7.9, 95% CI: 1.93, 32.34) and in the hiring process (OR 6.81, 95% CI: 1.98, 23.48) compared to those experiencing no racial discrimination after adjusting for race, gender, age and income.

CONCLUSION

The location in which a student experienced racial discrimination impacted the extent to which the racial discrimination was associated with food security status. Further research is needed to explore potential mechanisms for how racial discrimination may lead to food insecurity.

Food Pantry Referral and Utilization in a Pediatric Primary Care Clinic

INTRODUCTION

This study aimed to characterize progression from screening for food insecurity risk to on-site food pantry referral to food pantry utilization in pediatric primary care.

METHODS

This retrospective study included 14,280 patients aged 0-21 years with ≥1 pediatric primary care visit from March 2018 to February 2020. Analyses were conducted in 2020-2022 using multivariable regression to examine patient-level demographic, clinical, and socioeconomic characteristics and systems-related factors associated with progression from screening positive for food insecurity risk to food pantry referral to completing ≥1 food pantry visit.

RESULTS

Of patients screened for food insecurity risk, 31.9% screened positive; 18.5% of food-insecure patients received an on-site food pantry referral. Among patients referred, 28.9% visited the food pantry. In multivariable models, higher odds of referral were found for patients living near the clinic (AOR=1.28; 95% CI=1.03, 1.59), for each additional health-related social need reported (AOR=1.23; 95% CI=1.16, 1.29), and when the index clinic encounter occurred during food pantry open hours (AOR=1.62; 95% CI=1.30, 2.02). Higher odds of food pantry visitation were found for patients with a preferred language of Haitian Creole (AOR=2.16; 95% CI=1.37, 3.39), for patients of Hispanic race/ethnicity (AOR=3.67; 95% CI=1.14, 11.78), when the index encounter occurred during food pantry open hours (AOR=1.96; 95% CI=1.25, 3.07), for patients with a clinician letter referral (AOR=6.74; 95% CI=3.94, 11.54), or for patients with a referral due to a screening-identified food emergency (AOR=2.27; 95% CI=1.30, 3.96).

CONCLUSIONS

There was substantial attrition along the pathway from screening positive for food insecurity risk to food pantry referral and utilization as well as patient-level characteristics and systems-related factors associated with successful referrals and utilization.

Food Insecurity, Neighborhood Food Environment, and Health Disparities: State of the Science, Research Gaps and Opportunities

Food insecurity and the lack of access to affordable, nutritious food are associated with poor dietary quality and an increased risk of diet-related diseases, including cardiovascular disease, diabetes, and certain types of cancer. Those of lower socioeconomic status and racial and ethnic minority groups experience higher rates of food insecurity, are more likely to live in under-resourced food environments, and continue to bear the greatest burden of diet-related chronic diseases in the United States. Despite the growing body of literature in this area, there are still significant gaps in our understanding of the various pathways that link food insecurity and neighborhood food environments to racial/ethnic and socioeconomic disparities in health and the most effective intervention strategies to address these disparities. To better understand the science in this area, the National Institutes of Health, in collaboration with the Centers for Disease Control (CDC) and Prevention and the United States Department of Agriculture (USDA), convened a virtual 3-d workshop 21-23 September 2021: Food Insecurity, Neighborhood Food Environment, and Nutrition Health Disparities: State of the Science. The workshop brought together a diverse group of researchers, practitioners, policymakers, and federal partners with expertise in nutrition, the food environment, health and social policy, and behavioral and social sciences. The workshop had the following 3 research objectives: 1) summarize the state of the science and knowledge gaps related to food insecurity, neighborhood food environments, and nutrition health disparities, 2) identify research opportunities and strategies to address research gaps, and 3) examine evidence-based interventions and implementation approaches to address food insecurity and neighborhood food environments to promote health equity. This article summarizes workshop proceedings and describes research gaps and future opportunities that emerged from discussions.

Maternal periconception food insecurity and postpartum parenting stress and bonding outcomes

Food insecurity during pregnancy is associated with various adverse pregnancy outcomes for the mother and infant, but less is known about the role of periconception food insecurity and its links to maternal and child wellbeing in the postpartum period. In a sample of 115 diverse (41% white) and predominately low-income mothers, results of hierarchical regression analyses showed that periconception food insecurity was positively associated with parenting stress at 2 months postpartum. A negative association between food insecurity and maternal-infant bonding at 6 months postpartum was mediated after controlling for prenatal depression, social support, and demographic factors. Findings highlight the need for maternal linkage to effective food security programs, such as United States-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for women during their childbearing years due to the critical importance of food security for maternal and infant well-being.

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes

AIM

We examined household food insecurity (HFI) and autonomic nervous system (ANS) function in a subset of low-income Latinos with type 2 diabetes with data from a stress management trial.

METHODS

InclusionLatino or Hispanic, Spanish speaking, age less than 18 years, ambulatory status, type 2 diabetes more than 6 months, A1c less than 7.0%. ExclusionPain or dysfunction in hands (e.g., arthritis) precluding handgrip testing; medical or psychiatric instability. HFI was assessed with the 6-item U.S. household food security survey module; with responses to > = 1 question considered HFI. An ANS dysfunction index was calculated from xix autonomic function tests which were scored 0 = normal or 1 = abnormal based on normative cutoffs and then summed. Autonomic function tests were: 1) 24-hour heart rate variability as reflected in standard deviation of the normal-to-normal (SDNN) heart rate acquired with 3-channel, 7-lead ambulatory electrocardiogram (Holter) monitors; 2) difference between the highest diastolic blood pressure (DBP) during sustained handgrip and the average DBP at rest; 3) difference between baseline supine and the minimal BP after standing up; and, from 24-hour urine specimens 4) cortisol, 5) normetanephrine, and, 6) metanephrine.

RESULTS

Thirty-five individuals participated, 23 (65.7%) of them were women, age mean = 61.6 (standard deviation = 11.2) years, HbA1c mean = 8.5% (standard deviation = 1.6) and 20 participants (57.1%) used insulin. Twenty-two participants (62.9%) reported HFI and 25 (71.4%) had one or more abnormal ANS measure. Independent t-tests showed that participants with HFI had a higher ANS dysfunction index (mean = 1.5, standard deviation = 0.9) than patients who were food secure (mean = 0.7, standard deviation = 0.8), p = 0.02. Controlling for financial strain did not change significance. Total ANS index was not related to glycemia, insulin use or other socioeconomic indicators. In this sample, HFI was associated with ANS dysfunction. Policies to improve food access and affordability may benefit health outcomes for Latinos with diabetes.

Increasing food insecurity severity is associated with lower diet quality

OBJECTIVE

Food insecurity may reduce diet quality, but the relationship between food insecurity severity and diet quality is under-researched. This study aimed to examine the relationship between diet quality and severity of household food insecurity.

DESIGN

A cross-sectional, online survey used the United States Department of Agriculture Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately or severely food insecure. The Australian Recommended Food Score (ARFS; scored 0–73) determined diet quality (ARFS total and sub-scale scores). Survey-weighted linear regression (adjusted for age, sex, income, education, location and household composition) was conducted.

SETTING

Tasmania, Australia.

PARTICIPANTS

Community-dwelling adults (aged 18 years and over).

RESULTS

The mean ARFS total for the sample (n 804, 53 % female, 29 % aged > 65 years) was 32·4 (sd = 9·8). As the severity of household food insecurity increased, ARFS total decreased. Marginally food-insecure respondents reported a mean ARFS score three points lower than food-secure adults (B = –2·7; 95 % CI (–5·11, –0·34); P = 0·03) and reduced by six points for moderately (B = –5·6; 95 % CI (–7·26, –3·90); P < 0·001) and twelve points for severely food-insecure respondents (B = –11·5; 95 % CI (–13·21, –9·78); P < 0·001). Marginally food-insecure respondents had significantly lower vegetable sub-scale scores, moderately food-insecure respondents had significantly lower sub-scale scores for all food groups except dairy and severely food-insecure respondents had significantly lower scores for all sub-scale scores.

CONCLUSIONS

Poorer diet quality is evident in marginally, moderately and severely food-insecure adults. Interventions to reduce food insecurity and increase diet quality are required to prevent poorer nutrition-related health outcomes in food-insecure populations in Australia.

The association between household food insecurity and healthcare costs among Canadian children

OBJECTIVE

To examine the relationship between household food insecurity and healthcare costs in children living in Ontario, Canada.

METHODS

We conducted a cross-sectional, population-based study using four cycles of the Canadian Community Health Survey (2007-2008, 2009-2010, 2011-2012, 2013-2014) linked with administrative health databases (ICES). We included Ontario children aged 1-17 years with a measure of household food insecurity (Household Food Security Survey Module) over the previous 12 months. Our primary outcome was the direct public-payer healthcare costs per child over the same time period (in Canadian dollars, standardized to year 2020). We used gamma-log-transformed generalized estimating equations accounting for the clustering of children to examine this relationship, and adjusted models for important sociodemographic covariates. As a secondary outcome, we examined healthcare usage of specific services and associated costs (e.g. visits to hospitals, surgeries).

RESULTS

We found that adjusted healthcare costs were higher in children from food-insecure than from food-secure households ($676.79 [95% CI: $535.26, $855.74] vs. $563.98 [$457.00, $695.99], p = 0.047). Compared with children living in food-secure households, those in insecure households more often accessed hospitals, emergency departments, day surgeries, and home care, and used prescription medications. Children from food-secure households had higher usage of non-physician healthcare (e.g. optometry) and family physician rostering services.

CONCLUSION

Even after adjusting for measurable social determinants of health, household food insecurity was associated with higher public-payer health services costs and utilization among children and youth. Efforts to mitigate food insecurity could lessen child healthcare needs, as well as associated costs to our healthcare systems.

Measuring food security in university students: A comparison of the USDA 10-item and six-item food security survey modules

We examined discordant food security (FS) status classification between the USDA 10-item and six-item FS Survey Modules (FSSMs) among students at a U.S. university. A random sample reflecting the University's sociodemographic composition was recruited by email in 2020. Respondents (N=2653) completed the FSSMs. FS status (binary: food secure/insecure; four-category: high/marginal/low/very low) was determined using the 10-item and six-item FSSMs. Seventy (2.6%) students were discordantly classified on binary FS and 238 (9%) on four-category FS. American Indian students, international students, Supplemental Nutrition Assistance Program participants, and students with child dependents or housing insecurity had higher odds of discordant classification.

Young Children's Development and Behavior: Associations with Timing of Household Food Insecurity in a Racially and Ethnically Diverse Early Head Start Sample

OBJECTIVE

The objective of this study was to assess the impact of household food insecurity (HFI) over time on behavioral and developmental health in early childhood while considering the impact of timing/persistence of HFI and potential differences among racially or ethnically minoritized children.

METHODS

Families from the Early Head Start Family and Child Experiences Study (N = 760) were followed longitudinally until age 3 years. Caregiver interview data were collected on HFI, problem behaviors (PBs), delays in development (DD), and sociodemographic information. Analysis of Covariances examined differences between persistent vs transient HFI. Multiple regressions examined the impact of HFI on PB and DD and whether this relation was stronger in racially or ethnically minoritized children.

RESULTS

The timing of HFI differentially affected PB, such that those with persistent HFI demonstrated greater PB than those with only early or only late HFI. A different pattern was identified for DD, in which those with late HFI had more DD than those with persistent HFI. Over and above other sociodemographics, including maternal risk factors and an income-to-needs ratio, HFI was associated with greater PB for children of all races and ethnicities. HFI was associated with more DD in non-Latino/a/e/x White families compared with non-Latino/a/e/x Black and Latino/a/e/x families.

CONCLUSION

Meaningful differences were found in how the persistence/timing of HFI is differentially associated with PB and DD. In addition, while controlling for socioeconomic risk, a cumulative risk effect was not observed in how HFI affected racially or ethnically minoritized children.

Prevalence and associations of poor mental health in the third year of COVID-19: U.S. population-based analysis from 2020 to 2022

BACKGROUND

Poorer mental health was found early in the COVID-19 pandemic, yet mental health in the third year of COVID-19 has not been assessed on a general adult population level in the United States.

METHODS

We used a nationally representative cross-sectional survey (Health Information National Trends Survey, HINTS 5 2020 n = 3,865 and HINTS 6 2022 n = 6,252). The prevalence of poor mental health was examined using a Patient Health Questionnaire-4 scale in 2020 and 2022. We also investigated the factors associated with poor mental health in 2022 using a weighted multivariable logistic regression adjusting for sociodemographic and health status characteristics to obtain the odds ratio (OR).

OUTCOMES

The prevalence of poor mental health in adults increased from 2020 to 2022 (31.5% vs 36.3 %, p = 0.0005). U.S. adults in 2022 were 1.28 times as likely to have poor mental health than early in the pandemic. Moreover, individuals with food insecurity, housing instability, and low income had greater odds of poor mental health (ORs=1.78-2.55). Adults who were females, non-Hispanic Whites, or age 18-64 years were more likely to have poor mental health (ORs=1.46-4.15).

INTERPRETATION

Mental health of U.S. adults worsened in the third year of COVID-19 compared to the beginning of the pandemic.

Food Insecurity and Experiences of Discrimination Among Caregivers of Hospitalized Children

BACKGROUND AND OBJECTIVES

Pediatric hospitals are adopting strategies to address food insecurity (FI), a stigmatizing condition, among families with children. We hypothesized that parents and other caregivers ("caregivers") from households with FI or marginal food security (MFS) are more likely to experience discrimination during their child's hospitalization.

METHODS

We analyzed data from 319 caregivers of children admitted to an urban, academic children's hospital and randomly assigned to the control arm of the double-blind randomized controlled CommunityRx-Hunger trial (November 2020 to June 2022, NCT R01MD012630). Household food security in the 30 days before admission and discrimination during hospitalization were measured with the US Household Food Security Survey and the Discrimination in Medical Settings Scale, respectively. We used logistic regression to model the relationship between food security status and discrimination, adjusting for gender, race, ethnicity, income, and partner status.

RESULTS

Most participants were African American or Black (81.5%), female (94.7%), and the parent of the hospitalized child (93.7%). FI and MFS were prevalent (25.1% and 15.1%, respectively). Experiences of discrimination during a child's hospitalization were prevalent (51.9%). Caregivers with FI had higher odds than caregivers with food security of experiencing discrimination (adjusted odds ratio = 2.0, 95% confidence interval 1.1-3.6, P = .03); MFS was not significantly associated with discrimination (P = .25). Compared with food secure caregivers, those with FI had higher odds of 5 of 7 experiences of discrimination assessed.

CONCLUSIONS

Among parents and other caregivers, household FI is associated with experiences of discrimination during a child's hospitalization.

Food Security as a Predictor of Global Pediatric Postburn Mortality

Food security (FS) is defined as access to sufficient and nutritious food. Children, especially those in low- and middle- income countries (LMICs), are disproportionately affected by low FS. We hypothesized high FS would be predictive of decreased pediatric postburn mortality in LMICs. Publicly-available, deidentified datasets were obtained from the World Health Organization's Global Burn Registry (GBR) and Economist Intelligence Unit's Global FS Index (GFSI). The GFSI calculates FS scores annually from intergovernmental organization data reviewed by a panel of experts. FS scores are reported on a 0 to 100 scale with 100 indicating the highest FS. Patients aged 0 to 19 yr were included; after linking GBR and GFSI datasets, countries with <100 burn patients were excluded. Data were analyzed with descriptive statistics and bivariate analyses. Multiple logistic regression controlling for confounders was used to quantify associations between mortality and FS score. Significance was set at P < 0.05. From 2016 to 2020, there were 2,246 cases including 259 deaths (11.5%) over nine countries. Those who died had a higher median age (7 [IQR 2, 15] vs 3 [2, 6] years, P < 0.001), higher proportion of females (48.6% vs 42.0%, P =0.048), and lower median FS score (55.7 [IQR 45.3, 58.2] vs 59.8 [IQR 46.7, 65.7], P < 0.001). Increasing FS score was associated with decreased odds of postburn mortality [multivariable odds ratio 0.78 (95% confidence interval 0.73 to 0.83), P < 0.001]. With the association between FS and mortality, international efforts to increase FS in LMICs may help improve pediatric burn patient survival.

Food insecurity is inversely associated with positive childhood experiences among a nationally representative sample of children aged 0-17 years in the USA

OBJECTIVE

We examined the association between food insecurity and positive childhood experiences (PCE).

DESIGN

Outcome measure was number of PCE and seven PCE constructs. Food insecurity was assessed with a three-category measure that ascertained whether the respondent could afford and choose to eat nutritious food. We then used bivariate and multivariable Poisson and logistic regressions to analyse the relationship between food insecurity and the outcome measures. The analyses were further stratified by age (≤ 5, 6-11 and 12-17 years).

SETTING

The National Survey of Children's Health (NSCH) from 2017 to 2020, a nationally representative sample of children and adolescents in the USA.

PARTICIPANTS

Parents/caregivers who reported on their children's experiences of PCE and food insecurity from the 2017-2020 NSCH (n 114 709).

RESULTS

Descriptively, 22·13 % of respondents reported mild food insecurity, while 3·45 % of respondents reported moderate to severe food insecurity. On multivariable Poisson regression analyses, there was a lower rate of PCE among children who experienced mild (incidence rate ratio (IRR) = 0·93; 95 % CI 0·92, 0·94) or moderate/severe food insecurity (IRR = 0·84; 95 % CI 0·83, 0·86) compared with those who were food secure. We found an inverse relationship between food insecurity and rate of PCE across all age categories.

CONCLUSIONS

Our study finding lends evidence to support that interventions, public health programmes, as well as public health policies that reduce food insecurity among children and adolescents may be associated with an increase in PCE. Longitudinal and intervention research are needed to examine the mechanistic relationship between food insecurity and PCE across the life course.

Experiencing food insecurity in childhood: influences on eating habits and body weight in young adulthood

OBJECTIVE

To examine how food insecurity in childhood up to adolescence relates to eating habits and weight status in young adulthood.

DESIGN

A longitudinal study design was used to derive trajectories of household food insecurity from age 4·5 to 13 years. Multivariable linear and logistical regression analyses were performed to model associations between being at high risk of food insecurity from age 4·5 to 13 years and both dietary and weight outcomes at age 22 years.

SETTING

A birth cohort study conducted in the Province of Quebec, Canada.

PARTICIPANTS

In total, 698 young adults participating in the Québec Longitudinal Study of Child Development.

RESULTS

After adjusting for sex, maternal education and immigrant status, household income and type of family, being at high risk (compared with low risk) of food insecurity in childhood up to adolescence was associated with consuming higher quantities of sugar-sweetened beverages (ßadj: 0·64; 95 % CI (0·27, 1·00)), non-whole-grain cereal products (ßadj: 0·32; 95 % CI (0·07, 0·56)) and processed meat (ßadj: 0·14; 95 % CI (0·02, 0·25)), with skipping breakfast (ORadj: 1·97; 95 % CI (1·08, 3·53)), with eating meals prepared out of home (ORadj: 3·38; 95 % CI (1·52, 9·02)), with experiencing food insecurity (ORadj: 3·03; 95 % CI (1·91, 4·76)) and with being obese (ORadj: 2·01; 95 % CI (1·12, 3·64)), once reaching young adulthood.

CONCLUSION

Growing up in families experiencing food insecurity may negatively influence eating habits and weight status later in life. Our findings reinforce the importance of public health policies and programmes tackling poverty and food insecurity, particularly for families with young children.

Development and Validation of an Abbreviated Child and Adult Food Security Scale for Use in Clinical and Research Settings in the United States

BACKGROUND

Food insecurity (FI) prevalence was consistently >10% over the past 20 years, indicating chronic economic hardship. Recession periods exacerbate already high prevalence of FI, reflecting acute economic hardship. To monitor FI and respond quickly to changes in prevalence, an abbreviated food security scale measuring presence and severity of household FI in adults and children is needed.

OBJECTIVE

Our aim was to develop an abbreviated, sensitive, specific, and valid food security scale to identify severity levels of FI in households with children.

DESIGN

Cross-sectional and longitudinal survey data were analyzed for years 1998 to 2022.

PARTICIPANTS/SETTING

Participants were racially diverse primary caregivers of 69,040 index children younger than 4 years accessing health care in 5 US cities.

STATISTICAL ANALYSES PERFORMED

Sensitivity, specificity, positive and negative predictive values, accuracy, and area under the receiver operator curve were used to test combinations of questions for the most effective abbreviated scale to assess levels of severity of adult and child FI compared with the Household Food Security Survey Module. Adjusted logistic regression models assessed convergent validity between the Abbreviated Child and Adult Food Security Scale (ACAFSS) and health measures. McNemar tests examined the ACAFSS performance in times of acute economic hardship.

RESULTS

The ACAFSS exhibited 91.2% sensitivity; 99.6% specificity; 98.3% and 97.6% positive and negative predictive values, respectively; 97.7% accuracy; and a 99.6% area under the receiver operator curve, while showing high convergent validity.

CONCLUSIONS

The ACAFSS is highly sensitive, specific, and valid for detecting severity levels of FI among racially diverse households with children. The ACAFSS is recommended as a stand-alone scale or a follow-up scale after households with children screen positive for FI risk. The ACAFSS is also recommended for planning interventions and evaluating their effects not only on the binary categories of food security and FI, but also on changes in levels of severity, especially when rapid decision making is crucial.

Analysis of a Community Health Screening Program and the Factors Affecting Access to Care

Introduction Free community health fairs and screening initiatives can be effective in broadening access to care and improving health outcomes in historically marginalized communities. UTHealthCares is a community health-focused organization developed at the University of Texas Health Science Center in Houston. At the beginning of 2023, UTHealthCares oversaw a free community health fair in the Eastex-Jensen Area - a medically underserved area in Northeast Houston. The health fair consisted of four stations - vitals and body mass index collection, vision screening, blood glucose screening, and dental screening. Participants also received coronavirus disease 2019 vaccinations, referrals, and health education. The purpose of this study is to evaluate the effectiveness of the UTHealthCares community health fair while assessing the factors that influence participants' access to medical care. Methods After completing the health fair, participants filled out an optional questionnaire. The questionnaire contained items that assessed satisfaction with the health fair, improvements in managing health, and access to resources. We calculated descriptive statistics, including mean response and 95% confidence intervals for rating scale questions. We used the chi-squared test to evaluate the independence of categorical variables and the Mann-Whitney U test to evaluate differences in means between distributions. Results A total of 111 people participated in the health fair, 91 of which completed a questionnaire. When participants rated their satisfaction with the health fair, the average response was 4.62 out of five. Participants also reported that they were more comfortable managing areas of health related to the stations offered at the fair. Many participants reported limited access to fresh food and long travel times to the physician. Participants that traveled further to reach one resource also tended to have significantly higher travel times for the other: X2 (4, N=78)=28.04, p<0.0001. However, 77.8% of respondents reported that the lack of insurance or cost was their greatest barrier to seeing a medical provider, while only 2.47% reported the lack of transportation as their greatest barrier. Participants who reported having health insurance also had a significantly higher probability of visiting a medical provider when they had a health issue: U=928.5, p=0.0006. Conclusion Overall, participants reported high satisfaction with the health fair. Participants also gave valuable feedback for improving future community health initiatives. Although many participants reported travel times greater than 30 minutes to reach community resources, very few participants indicated that transportation was their largest barrier to accessing medical care. Instead, the lack of insurance and high costs seem to be participants' most significant hindrances. Therefore, interventions in the Eastex-Jensen area focused on expanding access to care should also include components that improve access to insurance.

Prevalence and socio-economic determinates of food insecurity in Veterans: findings from National Health and Nutrition Examination Survey

OBJECTIVE

To determine predictors of the association between being a Veteran and adult food security, as well as to examine the relation of potential covariates to this relationship.

DESIGN

Data collected during 2011-2012, 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) were pooled for analyses. Veterans (self-reported) were matched to non-Veterans on age, race/ethnicity, sex and education. Adjusted logistic regression was used to determine the odds of Veterans having high food security v. the combination of marginal, low and very low food security compared with non-Veterans.

SETTING

2011-2012, 2013-2014 and 2015-2016 NHANES.

PARTICIPANTS

1227 Veterans; 2432 non-Veterans.

RESULTS

Veteran status had no effect on the proportion of food insecurities between Veterans and non-Veterans reporting high (Veterans v. non-Veteran: 79 % v. 80 %), marginal (9 % v. 8 %), low (5 % v. 6 %) and very low (8 % v. 6 %) food security (P = 0·11). However, after controlling for covariates, Veterans tended to be less likely to have high food security (OR: 0·82 (95 % CI 0·66, 1·02), P = 0·07). Further, non-Hispanic White Veterans (OR: 0·72 (95 % CI 0·55, 0·95), P = 0·02) and Veterans completing some college (OR: 0·71 (95 % CI 0·50, 0·99), P < 0·05) were significantly less likely to experience high food security compared with non-Veterans.

CONCLUSION

This study supports previous research findings that after controlling for covariates, Veterans tend to be less likely to have high food security. It also highlights ethnicity and level of education as important socio-economic determinates of food security status in Veterans.

An Analysis of Socioeconomic Determinants of the Black-White Disparity in Food Insecurity Rates in the US

Previous research has not fully explored socioeconomic factors that influence the Black-White food insecurity disparities at the state and county levels in the United States. The goal of this study was to identify socioeconomic determinants associated with the Black-White food insecurity gap in the US at the state and county levels with rigorous quantitative investigation. The 2019 Map the Meal Gap dataset and multivariate regression analyses were used to identify factors associated with the prevalence of the Black-White disparity in food insecurity rates. Unemployment rate and median income gaps were found to be the strongest predictors of the Black-White disparity in food insecurity and the Black food insecurity rates in both state- and county-level models. Specifically, a 1% increase in Black unemployment rate compared with White unemployment rate was associated with a 0.918% and 0.232% increase in the Black-White disparity in food insecurity on average at the state and county levels, respectively. This study highlights the potential root causes of food insecurity and significant socioeconomic determinants associated with the Black-White food insecurity gap at the state and county levels in the US. Policymakers and program creators should implement action plans to address the income disparities and reduce unemployment rates among Blacks to eradicate this gap and ensure equity in food access between Blacks and Whites.