A policy perspective on household food security measures (extent, severity, and correlates): A population-based survey in Western Australia.

Comparing Food Security Before and During the COVID-19 Pandemic: Considerations When Choosing Measures

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

Food Insecurity Among Adults With Severe Mental Illness

The Need for Investment in Rigorous Interventions to Improve Child Food Security

To measure and describe the prevalence and severity of household food insecurity in a remote on-reserve First Nations community using the Household Food Security Survey Module (HFSSM) and to evaluate the perceived relevance of the HFSSM for this population. Household food security status was determined from the eighteen-item HFSSM following the classifications developed by Health Canada for the Canadian Community Health Survey, Cycle 2·2 Nutrition. One adult from each household in the community was invited to complete the HFSSM and to comment on its relevance as a tool to measure food security for First Nations communities. Sub-Arctic Ontario, Canada. Households (n 64). Seventy per cent of households were food insecure, 17% severely and 53% moderately. The prevalence of food insecurity in households with children was 76%. Among respondents from homes rated as having severe food insecurity, all (100 %) reported worrying that food would run out, times when food didn't last and there wasn't money to buy more, and times when they couldn't afford to eat balanced meals. The majority of respondents felt the HFSSM did not capture an accurate picture of food security for their situation. Aspects missing from the HFSSM included the high cost of market food and the incorporation of traditional food practices. A high prevalence of household food insecurity was reported in this community. On-reserve remote First Nations communities may be more susceptible to food insecurity than off-reserve Aboriginal populations. Initiatives that promote food security for this vulnerable population are needed.

Food Insecurity on College and University Campuses: A Context and Rationale for Solutions

A Consideration of the Evaluation of Demonstration Projects to End Childhood Hunger (EDECH)

The number of Australians seeking food aid has increased in recent years; however, the current variability in the measurement of food insecurity means that the prevalence and severity of food insecurity in Australia is likely underreported. This is compounded by infrequent national health surveys that measure food insecurity, resulting in outdated population-level food insecurity data. This review sought to investigate the breadth of food insecurity research conducted in Australia to evaluate how this construct is being measured. A systematic review was conducted to collate the available Australian research. Fifty-seven publications were reviewed. Twenty-two used a single-item measure to examine food security status; 11 used the United States Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM); two used the Radimer/Cornell instrument; one used the Household Food and Nutrition Security Survey (HFNSS); while the remainder used a less rigorous or unidentified method. A wide range in prevalence and severity of food insecurity in the community was reported; food insecurity ranged from 2% to 90%, depending on the measurement tool and population under investigation. Based on the findings of this review, the authors suggest that there needs to be greater consistency in measuring food insecurity, and that work is needed to create a measure of food insecurity tailored for the Australian context. Such a tool will allow researchers to gain a clear understanding of the prevalence of food insecurity in Australia to create better policy and practice responses.

The Household Food Security Survey Module (HFSSM) is an 18-item scale created and maintained by the US Department of Agriculture (USDA) that measures food insecurity in the United States. The HFSSM includes ten items that reference food hardships among adults in the household and eight items that reference food hardships among children. The scale was created and maintained using a dichotomous Rasch model (Engelhard et al., Educ Psychol Meas 78:1–19, 2017). However, the item responses that are collected for nine of the items are polytomous that are later dichotomized for creating the final scale. In 2006, the Committee on National Statistics (CNSTAT) reviewed the HFSSM and the USDA’s procedures for measuring food insecurity. They suggested modeling polytomous item responses with a polytomous model instead of dichotomizing item responses (Wunderlich and Norwood, Food insecurity and hunger in the United States: an assessment of the measure. The National Academies Press, Washington, DC, 2006). The purpose of this study is to explore modeling polytomous HFSSM items with a partial credit model, building on Nord’s (Assessing potential technical enhancements to the US household food security measures. US Department of Agriculture, Economic Research Service, 2012) work on the partial credit model and the HFSSM. The polytomous Rasch model is compared to the dichotomous Rasch model currently used by the USDA. The data suggest that the polytomous model provides better model-data fit, explaining 62% of the variation as opposed to 58% with the dichotomous model. The use of a polytomous model increases the precision of the estimates of food insecurity.

Household Food Insecurity in Middle- and High-Income Countries Before and During the COVID-19 Pandemic

Background: Food insecurity research has been mainly examined among young people. The root causes of food insecurity are closely linked to poverty, and social policies and income supplements, including public and private pensions, have been shown to sharply curb food insecurity into later life. However, social, economic, and political trends that are closely connected to social and health inequalities threaten to undermine the conditions that have limited food insecurity among older people until now. Exploring the prevalence and predictors of food insecurity among older people across Canada has important implications for domestic policies concerning health, healthcare, and social welfare. Methods: Data come from the Canadian Community Health Survey 2012 Annual Component (n = 14,890). Descriptive statistics and a generalized linear model approach were used to determine prevalence and estimate the associations between food insecurity—as measured by the Household Food Security Survey Module—and social, demographic, geographic, and economic factors. Results: Approximately 2.4% of older Canadians are estimated to be moderately or severely food insecure. Income was by far the strongest predictor of food insecurity (total household income <$20,000 compared to >$60,000, OR: 46.146, 95% CI: 12.523–170.041, p < 0.001). Younger older people, and those with a non-white racial background also had significantly greater odds of food insecurity (ages 75+ compared to 65–74, OR: 0.322, 95% CI: 0.212–0.419, p < 0.001; and OR: 2.429, 95% CI: 1.438–4.102, p < 0.001, respectively). Sex, home ownership, marital status, and living arrangement were all found to confound the relationship between household income and food insecurity. Prevalence of food insecurity varied between provinces and territories, and odds of food insecurity were approximately five times greater for older people living in northern Canada as compared to central Canada (OR: 5.189, 95% CI: 2.329–11.562, p < 0.001). Conclusion: Disaggregating overall prevalence of food insecurity among older people demonstrates how disparities exist among sub-groups of older people. The seemingly negligible existence of food insecurity among older people has obscured the importance, practicality, and timeliness of including this age group in research on food insecurity. The current research underscores the critical importance of an income floor in preventing food insecurity among older people, and contributes a Canadian profile of the prevalence and predictors of food insecurity among older people to the broader international literature.

BackgroundThe burden of food insecurity remains a public health challenge even in high income countries, such as Australia, and especially among culturally and linguistically diverse (CALD) communities. While research has been undertaken among several migrant communities in Australia, there is a knowledge gap about food security within some ethnic minorities such as migrants from the Middle East and North Africa (MENA). This study aims to determine the prevalence and correlates of food insecurity among Libyan migrant families in Australia.MethodsA cross-sectional design utilising an online survey and convenience sampling was used to recruit 271 participants, each representing a family, who had migrated from Libya to Australia. Food security was measured using the single-item measure taken from the Australian Health Survey (AHS) and the 18-item measure from the United States Department of Agriculture Household Food Security Survey Module (USDA HFSSM). Multivariable logistic regression was used to identify independent correlates associated with food insecurity.ResultsUsing the single-item measure, the prevalence of food insecurity was 13.7% whereas when the 18-item questionnaire was used, more than three out of five families (72.3%) reported being food insecure. In the multivariable logistic regression analysis for the single-item measure, those living alone or with others reported higher odds of being food insecure (AOR = 2.55, 95% CI 1.05, 6.21) compared to those living with their spouse, whereas higher annual income (≥AUD 40,000) was associated with lower odds of food insecurity (AOR = 0.30, 95% CI 0.11, 0.84). Higher annual income was also associated with lower odds of food insecurity (AOR = 0.49, 95% CI 0.25, 0.94) on the 18-item measure. On both single and 18-item measures, larger family size (AOR = 1.27, 95% CI 1.07, 1.49 and AOR = 1.21, 95% CI 1.01, 1.47 respectively) was associated with increased odds of food insecurity.ConclusionThis study provides evidence that food insecurity amongst Libyan migrants in Australia is a widespread problem and is associated with a number of sociodemographic and socio-economic factors. The findings of this study serve to contribute to the depth and breadth of food security research among vulnerable communities, in this instance Libyan migrant families.

Primary Subject areaSocial PaediatricsBackgroundThere are concerns of increased food insecurity rates during the COVID-19 pandemic, but there is no evidence to date about families with children with an acute or chronic illness. Parents with a child admitted to the hospital may also experience hospital-based food insecurity, defined as the inability of caregivers to afford adequate food during their child’s hospitalization.ObjectivesWe aimed to measure the prevalence of household and hospital-based food insecurity in an academic pediatric hospital setting during the COVD-19 pandemic. We also explored the effects of food insecurity on parental distress and overall caregivers’ experiences obtaining food during their hospital stay.Design/MethodsThis was a cross-sectional study from April to October 2020. Household food insecurity was measured using the 18-item U.S. Household Food Security Survey Module. Three adapted questions about hospital-based food insecurity were added. Parental distress was measured with the validated Distress Thermometer for Parents: “0” indicates “no distress” and “10” indicates “extreme distress”. Descriptive statistics were used to assess the proportions of food insecurity. Linear regression models were used to explore the relationship between food insecurity and parental distress adjusted for potential confounders. To explore caregivers’ experiences we included one open-ended question in our survey, asking: “Do you have any other feedback regarding your food situation during your child’s hospital admission?”. Recurrent themes were identified using qualitative analysis.Results851 families were reached by telephone and 775 (91.0%) provided consent to participate. 435 (56.1%) completed at least one questionnaire [Figure 1 Study Flow Diagram]. Caregivers described a high prevalence of household (34.2%) and hospital-based (38.0%) food insecurity. Both adult (B= 0.21 [95% CI 0.07-0.36]), child (B= 0.38 [95% CI 0.10-0.66]) and hospital-based (B= 0.56 [95% CI 0.30-0.83]) food insecurity were significantly associated with parental distress independent of covariates [Table]. In the qualitative analysis, the financial burden and emotional and practical barriers obtaining food in the hospital were identified as important themes. Parents also commented that they “need to eat to be able to take part in the care of their child during hospitalization”.ConclusionBoth household and hospital-based food insecurity were highly prevalent in caregivers and significantly associated with parental distress, independent of covariates. High parental distress is known to be associated with a child’s maladjustment to illness and adherence with medical treatment. Hospitals need to strongly consider reducing barriers for parents to obtain food for themselves during their child’s admission in order to reduce parental distress.

BackgroundSocial determinants of health (SDH), including food insecurity, are associated with depression in the general population. This study estimated the prevalence of depression and food insecurity and evaluated the impact of food insecurity and other SDH on depression in adults with rheumatoid arthritis (RA).MethodsAdults (≥ 18 years) with RA were identified from the 2013–2014 and 2015–2016 National Health and Nutrition Examination Survey (NHANES). Depression was defined as a score of ≥ 5 (mild depression: 5–9; moderate-to-severe depression: 10–27) using the Patient Health Questionnaire-9 (PHQ-9). Food insecurity was assessed with the 18-item US Household Food Security Survey Module. Adults with household-level marginal-to-very-low food security were classified as experiencing food insecurity. The prevalence of depression and food insecurity among participants with RA were estimated. Weighted logistic regression was used to evaluate the association between depression and participants’ characteristics including SDH. Penalized regression was performed to select variables included in the final multivariable logistic regression.ResultsA total of 251 and 276 participants from the 2013–2014 and the 2015–2016 NHANES, respectively, had self-reported RA. The prevalence of depression among these participants was 37.1% in 2013–2014 and 44.1% in 2015–2016. The prevalence of food insecurity was 33.1% in 2013–2014 and 43.0% in 2015–2016. Food insecurity was associated with higher odds of having depression (OR 2.17, 95% CI 1.27, 3.72), and the association varied by depression severity. Compared with participants with full food security, the odds of having depression was particularly pronounced for those with very low food security (OR 2.96, 95% CI 1.48, 5.90) but was not significantly different for those with marginal or low food security. In the multivariable regression, being female, having fair/poor health condition, any physical disability, and ≥ 4 physical limitations were significantly associated with depression.ConclusionsIn adults with self-reported RA, the prevalence of depression and food insecurity remained high from 2013 to 2016. We found that depression was associated with SDH such as food insecurity, although the association was not statistically significant once adjusted for behavioral/lifestyle characteristics. These results warrant further investigation into the relationship between depression and SDH among patients with RA.

BackgroundHigh rates of food insecurity are documented among Inuit households in Canada; however, data on food insecurity prevalence and seasonality for Inuit households with children are lacking, especially in city centres. This project: (1) compared food consumption patterns for households with and without children, (2) compared the prevalence of food insecurity for households with and without children, (3) compared food consumption patterns and food insecurity prevalence between seasons, and (4) identified factors associated with food insecurity in households with children in Iqaluit, Nunavut, Canada.MethodsRandomly selected households were surveyed in Iqaluit in September 2012 and May 2013. Household food security status was determined using an adapted United States Department of Agriculture Household Food Security Survey Module. Univariable logistic regressions were used to examine unconditional associations between food security status and demographics, socioeconomics, frequency of food consumption, and method of food preparation in households with children by season.ResultsHouseholds with children (n = 431) and without children (n = 468) participated in the survey. Food insecurity was identified in 32.9% (95% CI: 28.5–37.4%) of households with children; this was significantly higher than in households without children (23.2%, 95% CI: 19.4–27.1%). The prevalence of household food insecurity did not significantly differ by season. Demographic and socioeconomic characteristics of the person responsible for food preparation, including low formal education attainment (ORSept = 4.3, 95% CI: 2.3–8.0; ORMay = 3.2, 95% CI: 1.8–5.8), unemployment (ORSept = 1.1, 95% CI: 1.1–1.3; ORMay = 1.3, 95% CI: 1.1–1.5), and Inuit identity (ORSept = 8.9, 95% CI: 3.4–23.5; ORMay = 21.8, 95% CI: 6.6–72.4), were associated with increased odds of food insecurity in households with children. Fruit and vegetable consumption (ORSept = 0.4, 95% CI: 0.2–0.8; ORMay = 0.5, 95% CI: 0.2–0.9), as well as eating cooked (ORSept = 0.5, 95% CI: 0.3–1.0; ORMay = 0.5, 95% CI: 0.3–0.9) and raw (ORSept = 1.7, 95% CI: 0.9–3.0; ORMay = 1.8, 95% CI: 1.0–3.1) fish were associated with decreased odds of food insecurity among households with children, while eating frozen meat and/or fish (ORSept = 2.6, 95% CI: 1.4–5.0; ORMay = 2.0, 95% CI: 1.1–3.7) was associated with increased odds of food insecurity.ConclusionsFood insecurity is high among households with children in Iqaluit. Despite the partial subsistence livelihoods of many Inuit in the city, we found no seasonal differences in food security and food consumption for households with children. Interventions aiming to decrease food insecurity in these households should consider food consumption habits, and the reported demographic and socioeconomic determinants of food insecurity.