Shining a Spotlight on Food Insecurity Research and Innovation.

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

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

BackgroundWomen living in urban informal settlements may be particularly vulnerable to the detrimental effects of the COVID-19 pandemic because of increased economic and psychosocial stressors in resource-limited environments. ObjectivesThe objective of this study was to assess the associations between food and water insecurity during the pandemic and depression among women living in the urban informal settlements in Makassar, Indonesia. MethodsWe implemented surveys at 3 time points among women enrolled in the Revitalizing Informal Settlements and their Environments trial. Depression was measured using the Center for Epidemiologic Studies Depression Scale—10 (CESD-10) between November and December 2019 and again between February and March 2021. Food insecurity was measured using questions from the Innovation for Poverty Action’s Research for Effective COVID-19 Reponses survey and water insecurity was measured using the Household Water Insecurity Experiences Short Form. Both were measured between August and September 2020. We built 3 multivariate quantile linear regression models to assess the effects of water insecurity, food insecurity, and joint food and water insecurity during the COVID-19 pandemic on CESD-10 score. ResultsIn models with the full sample (n = 323), food insecurity (β: 1.48; 95% CI: 0.79, 2.17), water insecurity (β: 0.13; 95% CI: −0.01, 0.26), and joint food and water insecurity (β: 2.40; 95% CI: 1.43, 3.38) were positively associated with CESD-10 score. In subgroup analyses of respondents for whom we had prepandemic CESD-10 scores (n = 221), joint food and water insecurity (β: 1.96; 95% CI: 0.78, 3.15) maintained the strongest relationship with CESD-10 score. A limitation of this study is that inconsistency in respondents from households across the survey waves reduced the sample size used for this study. ConclusionsOur results find a larger association between depression and joint resource insecurity than with water or food insecurity alone, underlining the importance of addressing food and water insecurity together, particularly as they relate to women’s mental health and well-being.

HIV/AIDS and food insecurity

Food insecurity is a major public health concern in the United States, particularly for pregnant and postpartum individuals. In 2020, ∼13.8 million (10.5%) U.S. households experienced food insecurity. However, the association between food security and pregnancy outcomes in the United States is poorly understood. The purpose of this review was to critically appraise the state of the evidence related to food insecurity as a determinant of health within the context of pregnancy in the United States. We also explored the relationship between food insecurity and pregnancy outcomes. PubMed, CINAHL, Web of Science, and Food and Nutrition Science databases were used. The inclusion criteria were peer-reviewed studies about food (in)security, position articles from professional organizations, and policy articles about pregnancy outcomes and breastfeeding practices. Studies conducted outside of the United States and those without an adequate definition of food (in)security were excluded. Neonatal health outcomes were also excluded. Included articles were critically appraised with the STROBE and Critical Appraisal Skills Program checklists. Nineteen studies met the inclusion criteria. Inconsistencies exist in defining and measuring household food (in)security. Pregnant and postpartum people experienced several adverse physiological and psychological outcomes that impact pregnancy compared with those who do not. Intersections between neighborhood conditions and other economic hardships were identified. Findings regarding the impact of food insecurity on breastfeeding behaviors were mixed, but generally food insecurity was not associated with poor breastfeeding outcomes in adjusted models. Inconsistencies in definitions and measures of food security limit definitive conclusions. There is a need for standardizing definitions and measures of food insecurity, as well as a heightened awareness and policy change to alleviate experiences of food insecurity.

Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV. A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria. Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity. From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm 3 , and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity. Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.

Association of food and housing insecurity with outcomes after revascularization for chronic limb-threatening ischemia.

Prevalence of Social Determinants of Health Among Sexual Minority Women and Men in 2017

Healthcare screening identifies factors that impact patient health and well-being. Hunger as a Vital Sign (HVS) is widely applied as a screening tool to assess food security. However, there are no common practice screening questions to identify patients who are nutrition insecure or acquire free food from community-based organizations. This study used self-reported survey data from a non-Medicaid insured adult population approximately one year after the start of the COVID-19 pandemic (2021). The survey examined the extent to which the HVS measure might have under-estimated population-level food insecurity and/or nutrition insecurity, as well as under-identified food and nutrition insecurity among patients being screened for social risks in the healthcare setting. Data from a 2021 English-only mailed/online survey were analyzed for 2791 Kaiser Permanente Northern California (KPNC) non-Medicaid insured members ages 35-85 years. Sociodemographics, financial strain, food insecurity, acquiring free food from community-based organizations, and nutrition insecurity were assessed. Data from respondents' electronic health records were abstracted to identify adults with diet-related chronic health conditions. Data were weighted to the age × sex × racial/ethnic composition of the 2019 KPNC adult membership. Differences between groups were evaluated for statistical significance using adjusted prevalence ratios (aPRs) derived from modified log Poisson regression models. Overall, 8.5% of participants reported moderate or high food insecurity, 7.7% had acquired free food from community-based organizations, and 13% had nutrition insecurity. Black and Latino adults were significantly more likely than White adults to have food insecurity (17.4% and 13.1% vs 5.6%, aPRs = 2.97 and 2.19), acquired free food from community-based organizations (15.1% and 15.3% vs 4.1%, aPRs = 3.74 and 3.93), nutrition insecurity (22.1% and 23.9% vs 7.9%, aPRs = 2.65 and 2.64), and food and nutrition insecurity (32.4% and 32.5% vs 12.3%, aPRs = 2.54 and 2.44). Almost 20% of adults who had been diagnosed with diabetes, prediabetes, ischemic CAD, or heart failure were food insecure and 14% were nutrition insecure. Expanding food-related healthcare screening to identify and assess food insecurity, nutrition insecurity, and use of community-based emergency food resources together is essential for supporting referrals that will help patients achieve optimal health.

Massachusetts implemented a Flexible Services program (FSP) under a Medicaid Section 1115 waiver to address food and housing insecurity for accountable care organization (ACO) beneficiaries. Little is known about the social, behavioral, and clinical outcomes associated with Medicaid social needs interventions. To compare 1-year changes in food and housing insecurity, diet, stress, and acute health care use between individuals who participated in the Massachusetts FSP and those who did not. This prospective cohort study enrolled adult Medicaid beneficiaries from 5 community health centers in 1 eastern Massachusetts ACO from December 2019 through December 2020. Participants who were enrolled in FSP were compared with propensity score-weighted FSP-eligible study participants who were not enrolled in FSP (hereafter non-FSP participants). All FSP participants completed surveys and dietary recalls at enrollment and then annually for 3 years. In-depth interviews were conducted with 27 FSP participants. All data analyses were conducted from August 2024 to April 2025. Enrollment in FSP. Primary outcomes were 1-year changes in food and housing insecurity, stress, dietary quality, and acute health care use. Secondary outcomes were changes in depression and anxiety symptoms. Annual surveys measured food insecurity (10-item US Department of Agriculture Food Security Scale Module; score range: 0-10, with ≥3 indicating food insecurity), housing insecurity (questions regarding current housing, moving ≥2 times in past year, and worrying about losing housing), and stress (the 10-item Perceived Stress Scale [PSS]; score range: 0-40, with ≥14 indicating moderate to severe stress). Diet quality was measured with the Healthy Eating Index-2020 (HEI-2020; score range: 0-100, with higher scores indicating healthier diet quality). Acute health care use included annual emergency department (ED) visits and acute hospitalizations. There were 153 FSP participant episodes (representing 153 study participants; mean [SD] age, 43.6 [10.8] years; 129 females [84.3%]) and 1495 non-FSP participant episodes (representing 610 unique study participants; mean (SD) age 43.2 (11.2) years; 464 females [76.1%]) in the sample. Before FSP enrollment, 111 (72.5%) had food insecurity, 68 (44.4%) had housing insecurity, and 55 (35.9%) had both. There were no differences between the FSP and non-FSP groups in changes in proportion of individuals with food insecurity (difference in change, 4.96%; 95% CI, -3.13% to 13.05%) or housing insecurity (difference in change, 2.75%; 95% CI: -5.39% to 10.88%). There were no differences between groups in HEI-2020 scores, PSS scores, or acute health care use. Participant interviews reflected a range of experiences associated with FSP, from favorable changes in social needs and health to persistent challenges related to cost of food and limited housing availability. This study of adult Medicaid beneficiaries found that FSP was not associated with short-term favorable changes in food or housing insecurity, diet, stress, or acute health care use. In interviews, FSP participants highlighted both the benefits and challenges of addressing social needs through such health system interventions.

Introduction Experiencing food and housing insecurity have been linked to adverse health outcomes, and disproportionately affect marginalized populations. Among Black college students, these insecurities have been linked to poor physical and mental health, including sleep disturbances. Given the significant role of sleep in overall well-being and academic success, it is essential to examine how food and housing insecurity contribute to sleep disturbance in this population. Methods The sample consisted of Black students attending a large predominantly White institute (n = 263, 82.37% female, Mage = 20.3 years, 19.4% low SES). Sleep disturbance was measured using the Pittsburgh Sleep Quality Index (PSQI), with 81.4% of participants classified as having poor sleep based on the established 5-point cutoff. Food insecurity was measured with the Food Insecurity Experience Scale (FIES), and housing insecurity was measured by 6 items of the USDA Housing Security Scale. A multiple linear regression model was conducted to examine the relationship between housing and food security status and sleep disturbance. Results The model explained 8.55% of the variance in sleep disturbance (R2=.085, p &amp;lt;.001). Housing insecurity was significantly associated with greater sleep disturbance (B=1.25, p &amp;lt;.05), indicating that housing-insecure participants reported higher sleep disturbance scores compared to their housing-secure peers. Among food security levels, participants classified as moderately food insecure reported significantly higher sleep disturbance scores (B=4.38, p &amp;lt;.05) compared to food-secure participants. Mildly food insecure (B=3.54, p =.104) and severely food insecure (B=2.74, p =.154) participants also reported higher sleep disturbance scores, though this was not statistically significant. In terms of gender, compared to male participants, those identifying as “other” reported significantly higher sleep disturbance scores (B=3.68, p &amp;lt;.01), while females showed higher sleep disturbance scores (B=1.27) approaching statistical significance (p=0.087). Conclusion This study highlights the significant impact of housing insecurity, varying levels of food insecurity on sleep disturbance, and gender-based disparities in sleep health among Black college students. Comprehensive interventions targeting these insecurities are essential to improving sleep outcomes and promoting overall well-being in this population. Support (if any) n/a

IntroductionWomen living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV‐related stigma—the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV—intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV‐related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV‐related stigma among women living with HIV in Canada.MethodsThis prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18‐month intervals between 2013 and 2018. To understand associations between food and housing security and HIV‐related stigma, we conducted linear mixed effects regression models. We adjusted for socio‐demographic characteristics associated with HIV‐related stigma.Results and discussionAmong participants (n = 1422), more than one‐third (n = 509; 36%) reported baseline food insecurity and approximately one‐tenth (n = 152, 11%) housing insecurity. Mean HIV‐related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV‐related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV‐related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV‐related stigma at the third wave.ConclusionsAmong women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV‐related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV‐related stigma requires identifying and dismantling resource insecurity‐related stigma drivers.

Measures Used with Populations with Food Insecurity: A Call for Increased Psychometric Validation

The definition of food insecurity is lack of access to sufficient safe food for normal growth and for an active and healthy life. Food insecurity may be geographically classified: In low-income countries, it may be characterized by undernutrition and frank starvation, while in higher-income ones, food insecurity is associated with high consumption of energy-dense foods of poor nutritional quality. This review highlights the relationship between food insecurity and CKD and its negative effect on kidney development, CKD progression, and health outcomes. In developed countries, compensatory eating behaviors as a coping strategy, subsequent health changes, and stress all work in a cyclic way, increasing disease onset and CKD progression. Food insecurity causes chronic stress, leading to visceral fat accumulation, insulin resistance, and diet-induced obesity, although the presence of multiple chronic conditions predicts food insecurity. Although data are scarce, in subjects at kidney disease risk, food insecurity is an additional factor for hospitalization, presence and development of kidney stones, progression to ESKD, and mortality. Moreover, food insecurity is a risk factor for the development of CKD in people with hypertension and diabetes. One of the most frequent methods for detecting food insecurity are questionnaires, although screening for and addressing food insecurity in primary care should be prioritized. Food insecurity being a social determinant of health directly linked to inadequate financial resources represents a risk factor for development, progression, and negative outcomes in CKD. In addition, political-economic items such as social policies, insufficient income, food advertising, inequitable education and low education attainment, food production, and marketing of unhealthy food should be considered. Interventions for addressing food insecurity need to be carefully planned due to the higher mortality of food-insecure individuals. Health care professionals should be educated to understand food insecurity, but resources for detecting and solving this global problem are needed.

Background: Food insecurity, or a lack of secure access to safe food, can be a precursor to nutritional problems (Campbell, 1991). It has been linked with a wide range of physical, mental and social health problems (Vozoris &amp; Tarasuk, 2003), has been associated paradoxically with obesity in adults (Adams et al., 2003), and has been shown to affect children's academic performance, weight gain and social skills (Jyoti et al., 2005). Refugees are thought to be at higher risk than most of suffering from food insecurity, as a result of a combination of both social and economic factors, and this was reflected in a pilot study in London reporting 100% food insecurity with 60% child hunger (Sellen et al., 2002). The current project aimed to ascertain the prevalence of food insecurity amongst a sample group of refugees in Edinburgh, and to explore associations between levels of food insecurity and practical food issues.Methods: A self‐completing questionnaire, available in nine community languages, was administered to a convenience sample of adult refugees attending an adult education project and the central mosque. It contained questions relating to sociodemographics, statements adapted from the Radimer/Cornell food security and hunger scale (Radimer et al., 1990), and practical food information/access questions relating to language difficulties, social support, difficulties of finding shops with appropriate foods, lack of knowledge of local cooking/recipes, and uncertainty over food choices (Sellen et al., 2002). The Radimer/Cornell scale categorises participants progressively as food secure, household insecure, individual insecure or insecure with child hunger, according to the answers that are given. Subjects were then grouped as food secure and insecure for the purposes of undertaking Fisher's exact test analysis to determine associations with the practical issues, and Spearman correlation analysis to investigate correlations.Results: Participants (n = 9) comprised a mixture of males (44.4%) and females (56%), most of whom (89%) had been living in the UK for more than 2 years. Results indicated that 56% were food insecure, with 11% reporting food insecurity with child hunger. There were no statistically significant associations or correlations between food insecurity and the practical food issues listed.Discussion: To the best available knowledge, this study represents the first application of the Radimer/Cornell food security/hunger scale to refugees settled in Scotland. Inferences from this study are limited because it reflects a small convenience sample from only two groupings, is limited to those literate in one of the nine community languages (78% had college/higher education), and most participants had been in the UK more than 2 years, and so may be expected to have obtained a certain amount of acculturation in this time.Conclusions: Lack of secure access to food is not an acceptable predicament for anyone seeking sanctuary in this country. This project, although small scale and with limitations, would suggest that this is a subject area requiring further study.References Adams, E.J., Grummer‐Strawn, L. &amp; Chavez, G. (2003) Food insecurity is associated with increased risk of obesity in Californian women. J. Nutr.133, 1070.Campbell, C.C. (1991) Food insecurity: a nutritional outcome or a predictor variable? J. Nutr.121, 408–415.Jyoti, D.F., Frongillo, E.A. &amp; Jones, S.J. (2005) Food insecurity affects school children's academic performance, weight gain and social skills. J. Nutr.135, 2381.Radimer, K.L., Olson, C.M. &amp; Campbell, C.C. (1990) Development of indicators to assess hunger. J. Nutr.120, 1544–1548.Sellen, D.W., Tedstone, A.E. &amp; Frize, J. (2002) Food insecurity among refugee families in East London: results of a pilot assessment. Public Health Nutr.5, 637–644.Vozoris, N.T., Tarasuk, V.S., 2003. Household Food Insufficiency is associated with poorer health. J. Nutr.133, 120.