Household and Pediatric Inpatient Food Insecurity: Analysis and Implications for National Efforts.

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

Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle‐income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross‐sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI‐HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log‐binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI‐HWI with child outcomes. Moderate‐severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI‐HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI‐HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.

Household food insecurity and inadequate water, sanitation, and hygiene (WASH) contribute to ill health. However, the interactions between household food insecurity, WASH and health have been rarely assessed concurrently. This study investigated compounded impacts of household food insecurity and WASH on self-reported physical and mental health of adults in the Vietnamese Mekong Delta. This cross-sectional survey interviewed 552 households in one northern and one southern province of the Vietnamese Mekong Delta. The survey incorporated previously validated tools such as the Short Form 12-item Health Survey, Household Food Insecurity Assessment Scale, and the Access and Behavioural Outcome Indicators for Water, Sanitation, and Hygiene. Physical and mental health were quantified using the physical health composite score (PCS) and mental health composite score (MCS), respectively. These measures were the dependent variables of interest for this study. Statistical analysis revealed that household food insecurity and using <50 litres of water per person per day (pppd) were independently associated with lower PCS (p<0.05), after adjusting for socio-economic confounders. Household food insecurity and lack of food availability, using <50 litres of water pppd, and the use of untreated drinking water were associated with lower MCS (p<0.05), with water usage being an effect modifier of the relationship between household food insecurity and MCS. The results indicate that being food insecure and having limited potable quality water had a compounding effect on MCS, compared to being individually either food insecure or having limited water. This study is one of only a few that have established a link between potable water availability, food insecurity and poorer physical and mental health. The results also indicate a need to validate national data with fine-scale investigations in less populous regions to evaluate national initiatives with local populations that may be at higher risk. Adopting joint dual-action policies for interventions that simultaneously address water and food insecurity should result in larger improvements in health, particularly mental health, compared to targeting either food or water insecurity in isolation.

IntroductionHousehold food insecurity and inadequate water, sanitation, and hygiene (WASH) contribute to ill health. However, the interactions between household food insecurity, WASH and health have been rarely assessed concurrently. This study investigated compounded impacts of household food insecurity and WASH on self-reported physical and mental health of adults in the Vietnamese Mekong Delta.Materials and methodsThis cross-sectional survey interviewed 552 households in one northern and one southern province of the Vietnamese Mekong Delta. The survey incorporated previously validated tools such as the Short Form 12-item Health Survey, Household Food Insecurity Assessment Scale, and the Access and Behavioural Outcome Indicators for Water, Sanitation, and Hygiene. Physical and mental health were quantified using the physical health composite score (PCS) and mental health composite score (MCS), respectively. These measures were the dependent variables of interest for this study.ResultsStatistical analysis revealed that household food insecurity and using <50 litres of water per person per day (pppd) were independently associated with lower PCS (p<0.05), after adjusting for socio-economic confounders. Household food insecurity and lack of food availability, using <50 litres of water pppd, and the use of untreated drinking water were associated with lower MCS (p<0.05), with water usage being an effect modifier of the relationship between household food insecurity and MCS. The results indicate that being food insecure and having limited potable quality water had a compounding effect on MCS, compared to being individually either food insecure or having limited water.ConclusionThis study is one of only a few that have established a link between potable water availability, food insecurity and poorer physical and mental health. The results also indicate a need to validate national data with fine-scale investigations in less populous regions to evaluate national initiatives with local populations that may be at higher risk. Adopting joint dual-action policies for interventions that simultaneously address water and food insecurity should result in larger improvements in health, particularly mental health, compared to targeting either food or water insecurity in isolation.

The literature exploring the relationship between food insecurity and obesity for preschool-aged children is inconclusive and suffers from inconsistent measurement. This paper explores the relationships between concurrent household and child food insecurity and child overweight as well as differences in these relationships by child gender using a sample of 2-5 year old children. Using measured height and weight and responses to the Household Food Security Survey Module collected from a sample of 438 preschool-aged children (mean age 39 months) and their mothers, logistic regression models were fit to estimate the relationship between household and child food insecurity and child BMI. Separate models were fit for girls and boys. Twenty-seven percent of children from food insecure households and 25 % of child food insecure children were overweight or obese (BMI ≥ 85 %). There were no statistically significant associations between either household or child food insecurity and BMI for the full sample. For girls, but not boys, household food insecurity was associated with BMI z-scores (β = 0.23, p = 0.01). Although food insecurity and overweight were not significantly associated, a noteworthy proportion of food insecure children were overweight or obese. Programs for young children should address food insecurity and obesity simultaneously by ensuring that young children have regular access to nutrient-dense foods.

Malnutrition, poor child feeding practices and low dietary diversity are common in low income households, where food insecurity is prevalent. Therefore, this study was designed to assess and compare nutritional status of children (aged 2-5 years) in food secure and insecure households of Kuyu woreda. A community based comparative, cross sectional study was conducted in March, 2016. Multi stages sampling methods were employed to select 612 children, out of which 304 children were from food secure and 308 from insecure households. Dietary diversity score was assessed using a 24 hrs recall method. Anthropometric measurements of children were taken and nutritional status was generated using WHO Anthro v.3.2.2. Statistical Package for Social Sciences version 20.0 was used to perform descriptive statistics, independent samples T test and chi-square test analyses. P value &lt;0.05 was considered as statistically significant. The prevalence of stunting, underweight and wasting was 48.7%, 36.7% and 20.5% respectively for children in food insecure households. While the prevalence of stunting was 43%, underweight 30.9% and wasting 16.8% for children in food secure households. Daily meal frequency; having breakfast, midmorning, afternoon and bedtime snack among children in food secure households were significantly higher than food insecure households (p&lt;0.05). In addition, children restriction and pressure during meal were significantly (p&lt;0.05) higher in food insecure households compared to their counterparts. Moreover, this study found that food secure and insecure households were significantly different in children's dietary diversity scores (x2=13.1, p&lt;0.001), child feeding practices (x2=11.2, p= 0.001), consumption of dairy products (x2=15.44, p&lt;0.001) and vitamin A rich fruits and vegetables (x2=8.37, p=0.004). Most importantly, the study revealed that nutritional statuses of children from food secure households were significantly better compared to those from their counterparts. Therefore, Productivity Safety Net Program with all responsible bodies should be intensified to improve the nutritional status, child feeding practices and dietary diversity scores of children in the study area. Keywords : under nutrition, children aged 2-5 years, feeding practices, food insecurity DOI : 10.7176/ALST/81-02 Publication date: August 31st 2020

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

Is Household Food Insecurity Associated with Overweight/Obesity Among Adults in CALABARZON Region, Philippines?

Household food insecurity is a widely used concept in high-income countries to describe “uncertainty about future food availability and access, insufficiency in the amount and kind of food required for a healthy lifestyle, or the need to use socially unacceptable ways to acquire food.” (Anderson, 1990). In the UK, research focused on food insecurity was relatively rare before the rapid spread of food banks and growing usage from 2010 but since then, has burgeoned (Loopstra and Lambie-Mumford, 2023). There was very little peer-reviewed literature on the topic in the UK when DEFRA commissioned a Rapid Evidence Assessment of evidence on food aid in the UK (Lambie-Mumford et al 2014), but there is now an established field of research on household food insecurity and responses to it that spans disciplines including public health and nutrition, social policy, politics, geography, food policy and systems. Government monitoring of food insecurity has also evolved over this time, with the FSA first including a food insecurity measure into the Food and You survey in 2016, and the DWP including the same in the FRS from 2019/20. The Agriculture Act 2020 requires the UK government to report on food security to Parliament at least once every three years, and the UK Food Security Report that is produced to fulfil this duty now includes reporting on data from these government surveys (Department for Environment, Food &amp; Rural Affairs, 2021). This rapidly developing field has resulted in a varied landscape of research and evidence on food insecurity. The FSA has an interest in advancing its research on household food insecurity in the UK as part of its strategy. The FSA works to protect consumers’ wider interests in relation to food, and the FSA strategy 2022-2027 recognises that people are worried about food affordability and insecurity and therefore they will continue to consider the impact of these issues across all work. To inform the FSA’s approach to future collaborations and research priorities on food insecurity in the UK, it was deemed a priority to first gain greater clarity on the scope of the research landscape already in existence in the UK. Thus, this research was commissioned to give the FSA an overview of household food insecurity data and the landscape of the type of research questions related to food insecurity that have been explored in the UK context. More specifically, the aims of the project were: to scope the landscape of research and data on household food insecurity in the UK, covering that produced by academia, civil society, and government departments and including publicly available datasets; and to identify the key gaps in the research landscape and inform priorities for the FSA’s work on household food insecurity going forward. Importantly, the task was not to describe the findings of this large body of research, but rather to identify the landscape of research questions asked in relation to food insecurity and the approaches taken to answer these. The areas focused on were research on definition, concept and measurement of food insecurity, drivers of individual/household-level access to food, experiences of different population sub-groups, outcomes related to food insecurity including those related to food safety, and responses to food insecurity at the national/local level (including those by third sector organisations and local and national governments).

Malnutrition, poor child feeding practices and low dietary diversity are common in low income households, where food insecurity is prevalent. Therefore, this study was designed to assess and compare nutritional status, feeding practices and dietary diversity scores of children (aged 2-5 years) in food secure and insecure households of Kuyu woreda. A community based comparative, cross sectional study was conducted in March, 2016. Multi stages sampling methods were employed to select 612 children, out of which 304 children were from food secure and 308 from insecure households. Dietary diversity score was assessed using a 24 hrs recall method. Anthropometric measurements of children were taken and nutritional status was generated using WHO Anthro v.3.2.2. Statistical Package for Social Sciences (SPSS) version 20.0 was used to perform descriptive statistics, independent samples T test and chi-square test analyses. P value <0.05 was considered as statistically significant. The prevalence of stunting, underweight and wasting was 48.7%, 36.7% and 20.5% respectively for children in food insecure households. While the prevalence of stunting was 43%, underweight 30.9% and wasting 16.8% for children in food secure households. Daily meal frequency; having breakfast, midmorning, afternoon and bedtime snack among children in food secure households were significantly higher than food insecure households (p<0.05). In addition, children restriction and pressure during meal were significantly (p<0.05) higher in food insecure households compared to their counterparts. Moreover, this study found that food secure and insecure households were significantly different in children's dietary diversity scores (x2=13.1, p<0.001), child feeding practices (x2=11.2, p= 0.001), consumption of dairy products (x2=15.44, p<0.001) and vitamin A rich fruits and vegetables (x2=8.37, p=0.004). Most importantly, the study revealed that nutritional statuses of children from food secure households were significantly better compared to those from their counterparts. Therefore, all responsible bodies should support poor communities through providing foods or cash money to improve the nutritional status, child feeding practices and dietary diversity scores of children in the study area.

Food and nutrition insecurity occurs when healthy and safe food cannot be obtained by socially acceptable means and arises as a result of complex interactions between socioeconomic and demographic determinants. These factors contribute to discrepancies in health and well-being between men and women and may also explain differential rates of food insecurity. The objectives of this cross-sectional study were to investigate the intersection between gender, education, nutrition knowledge and food security status within a high-income country context. Australian adults over 16years of age who identified as having primary responsibility for food in their household were recruited via social media and a panel. Respondents completed a self-administered survey that included sociodemographic data, nutrition-related knowledge and food security status. Food security was measured using the Australian Household Food and Nutrition Security Scale an adapted version of the United States Department of Agriculture Household Food Security Survey. Among the 1010 survey respondents, household food insecurity (HFI) was highly prevalent (43% were food insecure, with 26% of these severely food insecure). Gender may affect associations between education, nutrition knowledge and HFI. Education was significantly associated with HFI among women but not among men. Conversely, nutrition knowledge was significantly inversely associated with food security among men but not among women. Differences in determinants of HFI exist between men and women, and programs aimed at addressing food insecurity may be more effective if tailored accordingly to account for the social and demographic factors associated with HFI.

The prevalence of childhood overweight status is increasing. Some have suggested that childhood overweight is associated with food insecurity, defined as limited or uncertain access to enough nutritious food. The purpose of this work was to assess the association of household and child food insecurity with childhood overweight status. The National Health and Nutrition Examination Survey 1999-2002 uses a stratified multistaged probability sample and collects a broad array of data from a nationally representative sample of US citizens. All children 3 to 17 years old in this sample are included in these analyses. We measured BMI categorized as at risk for overweight or greater (> or = 85%) or overweight (> or = 95%) and household and child food security/insecurity using the US Food Security Scale. When compared with children from food-secure households, children from food-insecure households were more likely to demonstrate significant associations with being at risk for overweight or greater in the following demographic categories: 12 to 17 years, girls, white, and in households with income < 100% and > 4 times the federal poverty level. Household food insecurity is associated with child overweight status in children aged 12 to 17, girls, and children who live in households with incomes > 4 times the federal poverty level. Child food insecurity demonstrated the same associations with being at risk for overweight or greater, as did household food insecurity, but associations were also seen in 3- to 5-year-old children, boys, and Mexican American children. Child food insecurity is significantly associated with child overweight status for children aged 12 to 17, girls, white children, and children in families with income < or = 100% poverty level. Controlling for ethnicity, gender, age, and family poverty index level, childhood food insecurity is associated with a child being at risk for overweight status or greater, but not overweight status. Household and child food insecurity are associated with being at risk for overweight and overweight status among many demographic categories of children. Child food insecurity is independently associated with being at risk for overweight status or greater while controlling for important demographic variables. Future longitudinal research is required to determine whether food insecurity is causally related to child overweight status.

Despite Bangladesh’s remarkable progress in agricultural production over the past few decades, household food and nutrition insecurity persist, especially in rural areas. The nutrition security and dietary diversity are even more critical for women of reproductive age among smallholders. This study examined household food insecurity and dietary diversity of women of reproductive age in the rural areas of northwest Bangladesh. Using cross-sectional data collected from 252 smallholder households, we measured household food insecurity and dietary diversity of women of reproductive age by the Household Food Insecurity Access Scale and the Minimum Dietary Diversity for Women, respectively. Determinants of household food insecurity were examined, and associations between household food insecurity and low dietary diversity were determined. The majority of the households were mildly insecure (51.2%) followed by moderately insecure (27.4%). The households felt anxiety of food insecurity for more than six months a year (Food Security Index = 2.10 out of 4.00). The mean food group consumed by women was 4.63 indicating low dietary diversity and dominance of diets by grains and dark green leafy vegetables. The findings also indicate a significant and positive association between household food insecurity and low dietary diversity of women. Education of household heads, household size, access to information sources, access to credit support, and perceived impacts of climate change on crop production were identified as determinants of household food insecurity. The study recommends that appropriate interventions be formulated to improve the food and nutrition security in the study areas.

The aim of this study was to Assess and compare nutritional status and associated factors of 6 to 59 months old children from food secure and food insecure households in rural Kebeles of Saesie Tsaeda Emba district, Tigray, North Ethiopia. As a result, a comparative, cross sectional study was conducted on 841 children (421 from food secure and 420 from food insecure households) from February to March, 2014. Multistage sampling method was used to select Children from each kebele. Anthropometric measurements were entered and calculated using ENA for SMART 2007software then transferred to SPSS version 20 to be processed and analyzed. Bivariate and multivariable logistic regressions were used to identify associated factors of under nutrition at significance level p-value < 0.05. About (46.1%, 52.1%), (18.1%, 20.5%), and 7.1%, 12.6%) of the children from the food secure and food insecure kebelles were stunted, underweight and wasted respectively. Occupation of father, head of family, and duration of continued breast feeding were the factors associated with stunting in food secure households. Whereas age of the child, head of family, and duration of continued breast feeding were determinant factors for stunting in children from the food insecure households. Similarly, educational status of father, sex of the child, and current breast feeding status of the child were the factors associated with underweight for children from food secure households and age of mother, occupational status of father, sex of child, 1st complementary food given to the child, and main source of water to the household were the main predictors of underweight in the food insecure households. The factors associated with child wasting in the food secure households were age of the father and number of cattle owned by the household and age of child and main source of water to the household were the factors associated with child wasting from the food insecure households. Finally, under nutrition among under-five years of age children was very high in the population. Therefore, addressing food security and then nutrition security using the productive safety net program in harmony with participation of all responsible bodies is crucial; as children of the food secure households were at better nutritional outcomes when compared to those of food insecure households.

This study examines the issue of consumer agency within the food system as manifested by food secure and food insecure households in an urban neighborhood in the United States. Using a self-administered mail survey this study examines food retailer perception and shopping behaviour of food secure and insecure households in Lansing, Michigan. Food security represents a useful lens through which to examine the issue of agency since food, while a necessary part of life, is nonetheless something that is difficult to access for a large sector of the population. By examining both food secure and food insecure households, light is shed on some of the factors that lead to the relative ability of each group to successfully and reliably obtain food. In particular, this study focuses on the perception and behaviour of consumers in relation to the decision to shop, or not to shop, at various food retailers. Some theories of consumer behaviour tend to focus either on class related cultural elements which determine taste preferences while other theories focus on structural elements of the food system which force a limited selection onto various social groups. While certainly class culture influences taste preference to some extent, results from this study suggest that structural elements of the food system and economic differences between food secure and food insecure households have a larger influence on store choice than cultural preferences. In fact, both food secure and insecure households indicated similar sets of criteria used in determining store choices. However, in examination of actual shopping behaviours, this study found that food insecure households are more likely to shop at deep discounters and more likely to travel farther to obtain food. These results suggest that structural elements such as food retailer locations limit the range of shopping options of food insecure households when compared to food secure households. Keywords: food desert, food access, food security, consumer, food retailer