Food insecurity, school absenteeism and educational attainment of adolescents in Jimma Zone Southwest Ethiopia: a longitudinal study

Despite the high prevalence of adolescent food insecurity in Ethiopia, there is no study which documented its association with suboptimal dietary practices. The objective of this study is to determine the association between adolescent food insecurity and dietary practices. We used data on 2084 adolescents in the age group of 13–17 years involved in the first round survey of the five year longitudinal family study in Southwest Ethiopia. Adolescents were selected using residence stratified random sampling methods. Food insecurity was measured using scales validated in developing countries. Dietary practices were measured using dietary diversity score, food variety score and frequency of consuming animal source food. Multivariable regression models were used to compare dietary behaviors by food security status after controlling for socio-demographic and economic covariates.Food insecure adolescents had low dietary diversity score (P<0.001), low mean food variety score (P<0.001) and low frequency of consuming animal source foods (P<0.001). After adjusting for other variables in a multivariable logistic regression model, adolescent food insecurity (P<0.001) and rural residence (P<0.001) were negatively associated with the likelihood of having a diversified diet (P<0.001) and frequency of consuming animal source foods, while a high household income tertile was positively associated. Similarly, multivariable linear regression model showed that adolescent food insecurity was negatively associated with food variety score, while residence in semi-urban areas (P<0.001), in urban areas (P<0.001) and high household income tertile (P = 0.013) were positively associated. Girls were less likely to have diversified diet (P = 0.001) compared with boys.Our findings suggest that food insecurity has negative consequence on optimal dietary intake of adolescents. Food security interventions should look into ways of targeting adolescents to mitigate these dietary consequences and provide alternative strategies to improve dietary quality of adolescents in Southwest Ethiopia.

To examine the association between the local food environment and the severity of food insecurity among new families using community food security interventions in Montreal. In this cross-sectional study, we analyzed baseline data from 785 adults aged 18-65 years enrolled in the evaluation of the effects of organizations delivering community food security interventions in Montreal. The dependent variable was household food insecurity, while the independent variable was the local food environment, assessed through: location of the most frequently used grocery store, distance between the participant's residence and the community organization used, mode of transportation, walking time to the most frequently used grocery store, satisfaction with the acceptability and affordability of food available at the most frequently used grocery store, and self-reported difficulties in accessing food. We used polytomous logistic regression to estimate the association between household food insecurity and the local food environment. In all the models, we coded food security status in three categories: food security, moderate food insecurity and severe food insecurity. The last group was used as a reference group. Our data suggest that compared to households with severe food insecurity, those with moderate food insecurity (OR = 0.43, 95% CI: 0.28-0.62) and those with food security (OR = 0.13, 95% CI: 0.06-0.26) were less likely to report difficulties in accessing food due to food affordability. Food-secure households also had lower odds of reporting difficulties in accessing food due to transportation constraints (OR = 0.18, 95% CI: 0.06-0.55) compared with severe food-insecure households. Living a distance of between 1 and 2 km from the organization used was significantly correlated with moderate food insecurity (OR = 1.80, 95% CI: 1.12-2.88). The local food environment is associated with severity of household food insecurity among new families using community food security interventions in Montreal. Future studies should study the relationship between the local food environment and food insecurity across all dimensions of food access.

Household food insecurity (HFI) plays an important role in child malnutrition in many low-income countries. We determined the association between HFI and stunting and severe stunting among Rwandan children from the Gicumbi district, aged 6-59months using a cross-sectional study of 2,222 children. HFI factor was calculated by summing all seven HFI (access) frequency questions and was categorised into food security, mildly food insecurity, moderately food insecurity, and severe food insecurity. The association between stunting, severe stunting, and HFI was determined using the multiple logistic regression analyses that adjust for clustering and sampling weights. The odds of moderate and severe HFI were significantly higher among stunted children aged 6-59months than those who were not stunted (adjusted odds ratio [AOR]=1.43; 95% confidence interval [CI] [1.11, 1.84] and AOR=1.35; 95% CI [1.08, 1.69], respectively). Children from households with moderate food insecurity were 2.47 times more likely to be severely stunted (AOR=2.47; 95% CI [1.77, 3.46]), and those from households with severe food insecurity were more likely to be severely stunted (AOR=1.82; 95% CI [1.34, 2.48]), compared with children aged 6-59months from households with food security. Other factors included male children and children who did not attend monthly growth monitoring sessions. This study showed that moderate and severe HFI correlated with stunting and severe stunting. Interventions to improve stunting in Gicumbi children should also focus on male children, children who did not attend monthly growth monitoring sessions, and households with moderate and severe food insecurity.

The present study aims at measuring the association between household food insecurity and psychological distress in adolescents in Inuit communities, concurrently and overtime from childhood to adolescence. The study used measures of internalising behaviours (anxiety, withdrawn attitude, somatic complaints and depression) as indicators of psychological distress during adolescence, a concurrent measure of household food insecurity in adolescence and an assessment of longitudinal patterns of household food insecurity from childhood to adolescence. We collected descriptive information at birth, childhood and adolescence on potential confounders. Inuit communities of Nunavik in northern Quebec, Canada. The study consisted of 212 participants from the Nunavik Child Development Study, who have been assessed at birth, childhood (mean age = 11 years, range = 9-13 years) and adolescence (mean age = 18 years, range = 16-21 years). Concurrent severe household food insecurity in adolescence was associated with higher measures of psychological distress: depression (βstd = 0·26, P < 0·01) and withdrawn attitude (βstd = 0·20, P = 0·04). Persistent household food insecurity (both at childhood and adolescence) was associated with higher levels of adolescent depression (βstd = 0·18, P = 0·02) and anxiety (βstd = 0·17, P = 0·03). Adolescents from Nunavik living with higher food insecurity and those having experienced food insecurity in both childhood and adolescence were more likely to report symptoms of psychological distress. Considering the high level of distress experienced by young Inuit, existing initiatives to reduce food insecurity in Nunavik communities should be targeted to include children and adolescents.

This study aimed to examine the food security status of urban poor adolescents and its association with diet quality. A cross-sectional survey was conducted among 188 adolescents aged 13-18 yrs living in Kuala Lumpur, Malaysia. Household food insecurity and dietary intake data were collected using the Radimer/Cornell hunger and food insecurity instrument and 2-day 24-h dietary recalls, respectively. Diet quality was determined using the Malaysian Healthy Eating Index (HEI). Weight and height were measured and body mass index-for-age, as well as height-for-age z scores were calculated. The present study revealed that 47.9% of the adolescents experienced household food insecurity, 24.5% experienced individual food insecurity, 18.6% household food security, and 9.0% child hunger. The mean score of diet quality was 56.83 ± 10.09, with a significantly lower HEI score among food insecure adolescents (household food insecure, individual food insecure, and child hunger) than household food secure adolescents (P = 0.001). The differences between food secure and food insecure households were found to be significant for energy (P = 0.001) and nutrients including proteins (P = 0.006), carbohydrates (P = 0.005), dietary fiber (P = 0.001), folate (P < 0.001), and vitamin C (P = 0.006). The multiple linear regression showed that adolescents who experienced food insecurity (β = -0.328; P = 0.003) were found to be significantly associated with poor diet quality (F = 2.726; P < 0.01), wherein 13.3% of the variation in the diet quality was explained by the food security status. Experiencing food insecurity contributed to poor diet quality among urban poor adolescents. Further longitudinal studies are needed to comprehensively understand this association to improve food insecurity and diet quality among urban poor communities.

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

BackgroundWhile considerable research has been conducted on household food insecurity (HFI), little research has examined the effects of food donation programs on users’ living conditions. The Pathways study was established to investigate the long-term effects of food donation programs on food insecurity as well as other critical outcomes, such as diet, health, and social support. Herein, we describe the design of the Pathways Study and the participants’ characteristics at baseline.MethodsThe Pathways study is a prospective cohort study of 1001 food-aid users in Quebec (Canada). We recruited newly registered users of food donation programs from 106 community-based food-aid organizations that partnered with the study. Baseline data were collected through face-to-face interviews from September 2018 to January 2020, with planned follow-up interviews at 12 and 24 months after enrollment. Household food insecurity, diet, food competencies, food shopping behaviors, perceived food environment, health status, social support and isolation, sociodemographic characteristics, housing conditions, negative life events, and the impacts of COVID-19 were assessed with validated questionnaires.ResultsThe cohort included 1001 participants living in rural (n = 181), semi-urban (n = 250), and urban areas (n = 570). Overall, household food insecurity was reported as severe among 46.2% and moderate in 36.9% of participants. Severe household food insecurity was more prevalent in rural (51.4%) and urban (47.8%) areas compared to semi-urban (39%) areas. Overall, 76.1% of participants reported an annual income below C$20,000. Half (52%) had low education levels (high school or lower), 22.0% lived in single-parent households, and 52.1% lived alone. Most (62.9%) experienced at least one major financial crisis in the preceding year.ConclusionsResults show that newly registered users of food donation programs often have low-income and severe food insecurity, with major differences across geographical locations. The Pathways study is the first study designed to follow, over a 2-year period, a cohort of newly registered users of food donation programs and to quantify their trajectories of service use. Findings from the Pathways study might help adapt the community response to the strategies used by food-insecure households to feed themselves.

Household food insecurity is generally associated with poorer quality diets in Canada, but whether household food insecurity heightens the probability of inadequate micronutrient intakes is unknown. The objective of this research was to investigate how prevalence of micronutrient inadequacy differed by severity of household food insecurity among adults in Canada. Using the 2015 Canadian Community Health Survey Nutrition, this study included participants aged 19-64 years who completed up to two 24 h dietary recalls and provided details about household food insecurity (n=9486). Children and older adults were not included due to sample size limitations. Usual micronutrient intake distributions were estimated by a four-level measure of food insecurity status using the National Cancer Institute method. Welch's t tests assessed differences in prevalence of inadequacy for selected micronutrients. Prevalence differed for some micronutrients among those living in marginally and moderately food insecure compared to food-secure households. The greatest differences in prevalence of inadequacy were observed between severely food-insecure and food-secure households: vitamin A (60.0%, SE=11.9vs. 40.6%, SE=2.7, p<0.0001), vitamin B6 (42.7%, SE=9.1vs. 12.8%, SE=2.5, p<0.0001), folate (39.4%, SE=10.0vs. 15.9%, SE=2.2, p<0.0001), vitamin C (63.3%, SE=5.2vs. 29.1%, SE=2.8, p<0.0001), calcium (78.6%, SE=6.4vs. 58.7%, SE=1.3, p<0.0001), magnesium (75.6%, SE=9.5vs. 48.7%, SE=1.2, p<0.0001), and zinc (34.9%, SE=10.0vs. 23.2%, SE=2.4, p=0.0009). Apparent underreporting also differed by severity of food insecurity, with increased underreporting observed with worsening food insecurity. The probability of inadequate micronutrient intakes among adults rises sharply with more severe household food insecurity in Canada.

The objective of this study was to examine the influence of food insecurity status on gestational weight gain among low‐income Latinas living in Hartford, CT (N=228). Food insecurity status during pregnancy was assessed using a modified version of the U.S. Household Food Security Scale. Households were classified as food secure, mildly food insecure, moderately food insecure, or severely food insecure. The Institute of Medicine recommendations were used to classify women as gaining less/within the recommended amount of weight during pregnancy or above the recommended amount of weight during pregnancy. Multivariate logistic regression evaluated predictors of excessive gestational weight gain. Women from moderately food insecure households were 23 times more likely than those from food secure households to gain excessive weight during pregnancy (Odds Ratio=23.70; Confidence Interval=2.07–271.04). By contrast, women with mild or severe household food insecurity during pregnancy were not more likely than those from food secure households to gain excessive gestational weight. These findings suggest there is a U shaped relationship between household food insecurity status during pregnancy and excessive gestational weight gain among low‐income pregnant Latinas. Funded by the Connecticut NIH EXPORT Center of Excellence for Eliminating Health Disparities among Latinos (NIH‐NCMHD Grant # P20MD0017650).

Background: Undernutrition and overnutrition are considered a rising challenge among adolescents in low- and middle-income countries, including Lebanon, where overlapping economic, political, and public health crises have worsened food insecurity. Food and nutrition literacy in adolescents may serve as protective factors against food insecurity and its nutritional consequences. This study aims to evaluate the associations between adolescent and parental food and nutrition literacy with household and adolescent food insecurity, and explores their relationship with stunting and overweight/obesity. Methodology: A cross-sectional survey was conducted between March and July 2022 among 442 Lebanese adolescents (10–18 years) and one parent/caregiver per household, recruited via snowball sampling from all eight governorates. Validated tools assessed adolescent food and nutrition literacy, parental food literacy, household/adolescent food insecurity, and anthropometric status. Chi-square, t-tests, and multivariable logistic regressions identified factors associated with food insecurity, stunting, and overweight/obesity. Results: Higher adolescent food and nutrition literacy was significantly associated with lower odds of severe food insecurity (aOR = 0.43, 95% CI: 0.26–0.70). Higher parental food literacy scores were linked to reduced odds of severe household food insecurity (aOR = 0.94, 95% CI: 0.90–0.98). Severe food insecurity was more likely in households in Akkar and among adolescents not attending school or with poor food and nutrition literacy. Overweight/obesity was positively associated with attending private school and higher parental body mass index, but inversely associated with higher child food security and household crowding index. No significant association was found between food insecurity and stunting. Conclusions: Both adolescent and parental food and nutrition literacy are protective against severe food insecurity, highlighting the value of literacy-focused interventions alongside economic support measures. Addressing both educational and structural determinants may help break the cycle of malnutrition in crisis-affected Lebanese youth.

Family meals and food insecurity in Spanish adolescents

(DHS), Schlussel et al. examine the association between household food insecurity (HFI) and excess body weight/obesity among adult women, female ad-olescents, and children under five. Their results suggest that the nature of the relationship is a function of the life course stage. Historically, HFI has been associated with undernutrition in chil-dren and adults (females in particular), especially in poorer countries where adequate nutrition, sanitation, and healthcare are in short supply. More recently however, the paradoxical situa-tion of HFI and overweight and obesity has been demonstrated in high-income, middle-income, and in ascending- or transitional-income coun-tries. In addition to the life course stage, what is particularly interesting about this paradox is that the strength of the relationship between food se-curity status and excess body weight is also in-fluenced by environmental conditions and that there is a synergistic relationship between hu-man biology and culture and behaviors.In this paper, while the positive association between HFI and child obesity is not statistically significant, food-insecure adolescent females are about two times more likely to have excess weight when compared to their food-secure counter-parts. The likelihood of excess weight is nearly 1.5 times higher among food-insecure adult females than among food-secure women. On one hand, adult females with moderate food insecurity are at a 49% higher risk of being obese than their food-secure counterparts. On the other hand, the risk of excess weight among adolescent females is significantly higher for those with severe HFI (rather than moderate HFI) when compared to their food-secure counterparts.The authors suggest that the differences in excess weight gain/obesity by severity of food insecurity between adult women and adoles-cent females reflect that the latter are resistant to fat accumulation because of the physiologi-cal changes associated with puberty (e.g., ado-lescent growth spurt which requires additional energy for increases in skeletal dimensions and developmental changes associated with repro-ductive maturation). Additionally, the authors point to cultural practices and behavior related to body image and ideal body types as a pos-sible mechanism to explain the difference in

BackgroundChildren living in food insecure households have poorer mental health outcomes compared with their food-secure peers; however, the relationship between the severity of food insecurity and diagnosed mental health conditions...

Several studies have shown an association between food insecurity and adverse health outcomes.1–3 This association may be partially caused by the affordable nature of high caloric foods, which if consumed frequently, can result in obesity.4 This theory does not account for the association between food-insecure, undernourished adults and adverse health outcomes. Because of this gap in theory, alternate pathways from food insecurity to adverse health outcomes other than obesity are becoming an area of interest. Gowda et al. used National Health and Nutrition Examination Survey data to demonstrate an association between C-reactive protein (CRP) and food security in adults that was mediated by immune markers in the United States using National Health and Nutrition Examination Survey data (Table 1).5 However, it seems that in adolescents, because CRP and low body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) are not associated with food insecurity, we can postulate that the risk posed by food insecurity in adolescence may result from the consumption of lower priced food high in calories. TABLE 1— Associations between Food Insecurity and Body Mass Index in Adolescents: National Health and Nutrition Examination Survey, United States, 1999–2006 Gowda et al. observed that adults who were highly food insecure were 21% more likely to have the highest CRP levels. We did not observe any association when looking at adolescents aged 12 to 17 years (n = 6037) from the same population and using adjusted models with Gowda et al.’s definitions of CRP, food security, and biomarkers. Adults were 33% more likely to be obese if they were marginally food insecure and 74% more likely to be underweight if they were highly food insecure. Contrarily, in adolescents we found that being overweight (BMI = 25.00–29.99) was associated with being highly food insecure. Adolescents who experienced high food insecurity were 47% more likely to be overweight than those who were food secure. These results demonstrate that the detrimental effects of being food insecure in adolescents may occur in different pathways than in adults. This means that for adolescents, food insecurity should be intervened upon with adolescent-specific strategies, possibly through nutritional education interventions. It will be important to continue development of a knowledge base that will support public health programs designed to alleviate food insecurities in adolescents specifically, not only in the adult population.

Food insecurity is emerging as an important barrier to antiretroviral therapy (ART) adherence. The objective of this study was to determine if food insecurity is associated with poor ART adherence among HIV-positive adults in a resource-limited setting that uses the public health model of delivery. A cross-sectional study using a 1-time questionnaire and routinely collected pharmacy data. Participants were HIV-infected adults on ART at the public ART clinics in Windhoek, Namibia: Katutura State Hospital, Katutura Health Centre, and Windhoek Central Hospital. Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). Adherence was assessed by the pharmacy adherence measure medication possession ratio (MPR). Multivariate regression was used to assess whether food insecurity was associated with ART adherence. Among 390 participants, 7% were food secure, 25% were mildly or moderately food insecure and 67% were severely food insecure. In adjusted analyses, severe household food insecurity was associated with MPR <80% [odds ratio (OR), 3.84; 95% confidence interval (CI): 1.65 to 8.95]. Higher household health care spending (OR, 1.92; 95% CI, 1.02 to 3.57) and longer duration of ART (OR, 0.82; 95% CI: 0.70 to 0.97) were also associated with <80% MPR. Severe household food insecurity is present in more than half of the HIV-positive adults attending a public ART clinic in Windhoek, Namibia and is associated with poor ART adherence as measured by MPR. Ensuring reliable access to food should be an important component of ART delivery in resource-limited settings using the public health model of care.