Insecurity Factors Research Articles

Socio-Cultural Factors of Food Insecurity in Sierra Leone

Food crop production in Sierra Leone is dominated by rice. It is cultivated by almost all small-scale farmers and consumed in all Sierra Leonean households irrespective of income levels. This underscores the importance attached to rice as a major staple crop. Sierra Leone is a rice deficit nation. Available statistics indicate that between 1970 and 2000, the country was self-sufficient in rice production only in 1975. Between 1979 and 2000, annual domestic paddy production fell from 504,000 to 200,000 Mt. During the same period, the volume of imported rice to fill domestic production shortfalls increased from 30% to 60% of total rice consumption. The 1991-2002 civil war and associated insecurity throughout the rural areas resulted in a dramatic fall in production throughout the 1990s. Since the cessation of armed hostilities in 2002, the recovery of rice production in Sierra Leone has been impressive although self-sufficiency remains elusive. A peculiar feature of food availability in Sierra Leone (especially in rural communities) is its seasonality. Typically, there is widespread food scarcity in farming communities between the months of July and September each year. This seasonal food shortage is commonly referred to as the “hunger season." A plethora of explanations exist for the occurrence of the hunger season. The most frequently cited include insufficient supplies in store due to poor harvest; a lack of skills in storage; and crop loss due to inefficient processing/preservation techniques. This paper argues that apart from the production related explanations (such as insufficient supplies in store due to poor harvest; a lack of skills in storage; and crop loss due to inefficient processing/preservation techniques), several socio-cultural factors need to be considered in accounting for food insecurity in Sierra Leone. Keywords: Socio-cultural, food insecurity, food production, Sierra Leone DOI : 10.7176/DCS/9-10-07 Publication date :October 31 st 2019

Food Insecurity and Associated Factors Among Households in Areka Town, Southern Ethiopia

Food Insecurity and Associated Factors Among Households in Areka Town, Southern Ethiopia

Objective and perceived food environment and household economic resources related to food insecurity in older adults living alone in rural areas

BackgroundLimited attention has been paid to an association between food environment and household economic resources related to food expenditure in food-insecure seniors. The aim of the study was to investigate the relationship between factors of economic resource, food environment, and food insecurity in single seniors residing in rural areas of South Korea.MethodsA cross-sectional study was conducted in 170 single senior households aged 65 years or over residing in rural areas. Face-to-face interviews were performed to collect data on demographic characteristics, household economic resources/expenditure, food environmental factors, and food insecurity.ResultsAmong economic resources, generally limited food expenditures due to housing fees and heating costs during the winter were positively related to food insecurity. Among food environmental factors, food accessibility at community level such as food stores located far from home and inconvenient bus routes was related to food insecurity. The most explainable economic and food environment factors related to food insecurity by stepwise logistic regression analysis were the percentage of total expenditure on housing fee (OR = 1.021, 95% CI: 1.008–1.034), foods purchasing at super supermarket (OR = 0.398, 95% CI: 0.166–0.951), having difficulties in food purchasing due to food stores being located far from home (OR = 14.487, 95% CI: 5.139–40.842) and inconvenient bus routes (OR = 0.083, 95% CI: 0.015–0.460).ConclusionInadequate community food environment as well as limited household food resources were an important risk factor for food insecurity in Korean single rural seniors. Findings of this study could help us better understand how characteristics of household food resources and community food environment can serve as barriers or facilitators of food security among single older adults residing in rural areas.

Severe Food Insecurity, Gender-Based Violence, Homelessness, and HIV Risk among Street-based Female Sex Workers in Baltimore, Maryland.

Despite established links between food insecurity and HIV outcomes, no studies have examined the role of food insecurity among female sex workers (FSW) in the United States (US). The aim of this exploratory study was to identify correlates (structural vulnerability and health factors) of severe food insecurity among street-based FSW in Baltimore, Maryland using multivariable logistic regression. In adjusted models, FSW with severe food insecurity were at greater odds of recent homelessness, physical intimate partner violence, client condom refusal, and HIV infection. Multi-sectoral approaches must take into consideration the co-occurrence of structural and health vulnerabilities to food insecurity among FSW in the US, including those that address violence, housing, and HIV.

From “Informal” to “Local”: The Role of Data in Legitimizing and Supporting the Local Food Economy in Malawi

Local and regional food economies throughout Africa are critical to rural and urban food security and are common sources of income for men and women. Despite their importance, local agrifood systems are often described as “informal,” a framing that obscures their value and implies chaos, inefficiency, and backward­ness. Consequently, the importance of local food economies in relation to food security and livelihood is largely unexplored. City-Region Food SystemsAs critical nodes in regional food networks that link rural producers to city residents, urban retail markets offer important opportunities for legitimizing and strengthening regional food systems. Better understanding these markets through research is key to developing policies and interventions that address urban factors of food insecurity, such as the condition of infrastructure, municipal policies that govern the use of space, and consumer proximity to markets. This type of research can also inform how local and regional agrifood networks, institutions, and practices can be strengthened in the service of local agrifood economies in both rural and urban contexts. Our presentation and paper highlight significant findings from a collaborative research project conducted by Michigan State University and Lilongwe University of Agriculture and Natural Resources, the goal of which is to better describe and understand urban food exchange in Lilongwe, particularly in relation to sustainable livelihoods and food security. Findings from this work should inform municipal planning processes and other efforts to address urban food insecurity in Lilongwe.

Psychosocial Risk Factors of Food Insecurity in Puerto Ricans Living in the U.S. from Baseline to 5-year Follow Up (P04-041-19)

ObjectivesFood insecurity is prevalent among Puerto Ricans (PR) in the U.S. and is associated with worse mental health problems. However, the direction of the association cannot be determined from previous cross-sectional studies. In this study, we aim to explore the longitudinal associations between a group of psychosocial factors and changes in food insecurity status over 5 years among PR population. MethodsA total of 923 participants from the Boston Puerto Rican Health Study Cohort who completed both the baseline and 5-year interviews were included. Food insecurity (FI) was accessed by the 10-item USDA food-security/hunger scale. Acculturation was indicated by the constructed scale obtained from 7 questions on the use of English and/or Spanish for daily activities. Depression was measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Stress was measured by the Perceived Stress Scale (PSS). Social support from participant’s network was characterized by type (emotional and tangible support), duration, and frequency of the support. Social and community support and assistance were accessed by reported numbers of social services used and social activities engaged in. Th number of good and bad major life events were calculated by counting affirmed events on a researcher-provided list. Multivariable logistic regression was applied to assess the association between psychosocial factors and becoming FI over 5 years, adjusting for age, gender, education level, and household income. ResultsThe prevalence of FI at baseline and 5-y was 27.4% and 16.5%, respectively. Over the 5 years, 11.5% of subjects became FI and 65.9% had no change in FI status. In the adjusted model, we observed that depression [OR = 1.04 (1.00, 1.08)] and stress score at baseline [OR = 1.07 (1.01, 1.13)] and their increment scores from baseline to 5-year [Depression: OR = 1.03 (1.00, 1.06); stress score: OR = 1.06 (1.02,1.10)] significantly increased the odds of becoming FI. ConclusionsThe onset of and worsened depression and stress may increase the risk of food insecurity among Puerto Ricans. There is likely a vicious cycle between adverse psychosocial environment, poor mental health and food insecurity in vulnerable minorities in the U.S. Funding SourcesThe Summer 2018 Undergraduate Research Award from the College of Health and Human Development, Penn State.

Quality of life of older women living with HIV: comparative assessment of physical and mental health-related markers using a large Canadian Sexual and Reproductive Health Cohort Study

Objective: This study assessed and compared physical and mental health components of quality of life (QoL) for older and younger women living with HIV (WLWH).Method: Using survey data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study, demographic, well-being, and physical and mental health-related QoL (HR-QoL) variables were compared between older (≥50 years) and younger (<50 years) WLWH. As the only significantly different QoL component, bivariate analyses and linear regression were used to assess factors associated with physical HR-QoL of older women.Results: The sample frame comprised 1,422 women (28.0% older women). Younger WLWH’s mean age was 37.8 years (SD = 7.4) compared to older WLWH (55.8 years, SD = 5.3). Compared to younger WLWH, older WLWH had poorer physical HR-QoL (40.0 vs. 50.7; p < 0.001) but similar mental HR-QoL (42.7 vs. 42.1; p > 0.001). Older WLWH had lower social support (p < 0.001) with no significant differences in depressive symptoms or resilience. Resilience was associated with improved physical HR-QOL. Food insecurity, poorer mental HR-QoL and depressive symptoms were associated with poorer physical health.Discussion: Compared to younger WLWH, older WLWH had poorer physical HR-QoL, which was associated with resilience, food insecurity and mental health factors, highlighting the complex interactions of health-related social-ecological factors impacting aging WLWH.

Food insecurity and work impairment in people with severe mental disorders in a rural district of Ethiopia: a cross-sectional survey

PurposeIn this study, we aimed to identify factors associated with severe food insecurity and work impairment in people with severe mental disorders (SMD) in a rural African setting, with a view to identifying potential areas for intervention.MethodsA community-based, cross-sectional survey was conducted in Sodo district, south central Ethiopia. Key informant-identified people with possible SMD were referred for assessment by trained primary care workers and received confirmatory psychiatric diagnoses from psychiatric nurses using a standardized clinical interview. Food insecurity was measured using a locally validated measure, the Household Food Insecurity Access Scale (HFIAS). Work impairment was assessed using the Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool. Potential moderator variables were specified a priori.ResultsA total of 282 people with SMD participated in the study. The proportion of participants reporting severe food insecurity was 32.5% (n = 94), with 53.6% (n = 147) of participants reporting severe work impairment. In the multivariable model, severe food insecurity was associated with poor social support, experience of negative discrimination, higher disability and lower household annual income, but not with symptom severity or work impairment. Work impairment was associated significantly with symptom severity and disability.ConclusionWork impairment and food insecurity were associated with distinct explanatory factors: predominantly social factors associated with food insecurity and clinical factors associated with work productivity. Longitudinal and intervention studies are needed to evaluate the extent to which clinical interventions need to be augmented by social interventions to alleviate food insecurity in people with SMD.

Research on Flight Operational Quality Assurance Based on ROM Concept

The flight operational quality management method based on Routine Operational Measure (ROM) can visually find hidden insecurity factors during flight operation and provide pilots directions in enhancing technologies and risk warning by completing collection off light segment data of aircrafts in routine operations and carrying out the analysis and research on flight data. Based on the theoretical analysis and the needs of airlines, this paper designs and implements the flight operational quality management system based on ROM so that the flight operational quality management of civil aviation of China can realize its critical transformation from a fleet to an individual and from ex-post to ex-ante.

Insecurity: Urban Kano Perception Index

Domestic insecurity characterizes Nigeria in the 21st century. Despite the current status, there is still a dearth of literature that could sufficiently depict the problem. This study aimed at knowledge contribution vis-à-vis policy formulation, methods, and literature. The perception index computed provided a clue on the contributing factors of urban Kano insecurity based on their statistical weight. The method used was quantitative using a questionnaire via a purposive sampling technique. The sample size was 480 but only 456 were finally utilized, as 24 were lost to nonreturn and outlying cases. The obtained result indicated that unemployment is the highest contributing factor to urban Kano insecurity. To combat insecurity, provision of employment opportunities to the populace must be the top priority. Also, there must be a public-welfare-oriented leadership. Policing deficiencies must be fixed at all cost and corruption should be eliminated from all societal sectors. These tasks demand authorities/public collaborative efforts.

"A Lot of People Are Struggling Privately. They Don't Know Where to Go or They're Not Sure of What to Do": Frontline Service Provider Perspectives of the Nature of Household Food Insecurity in Scotland.

This qualitative study explored frontline service providers’ perceptions of the nature of food insecurity in Scotland in 2015 to inform national policy and the provision of locally-based support for ‘at risk’ groups. A country-wide in-depth interview study was undertaken with informants from 25 health, social care, and third sector organisations. The study investigated informants’ perspectives associated with how food insecurity was manifesting itself locally, and what was happening at the local level in response to the existence of food insecurity. Data analysis revealed three key themes. First, the multiple faces and factors of food insecurity involving not only increased concern for previously recognised ‘at risk of food insecurity’ groups, but also similar concern held about newly food insecure groups including working families, young people and women. Secondly, respondents witnessed stoicism and struggle, but also resistance amongst some food insecure individuals to external offers of help. The final theme identified community participation yet pessimism associated with addressing current and future needs of food insecure groups. These findings have important implications for the design and delivery of health and social policy in Scotland and other countries facing similar challenges.

Water insecurity, illness and other factors of everyday life: A case study from Choma District, Southern Province, Zambia

Recent reports from the UN find that 2.6 billion people have gained access to improved drinking water sources since 1990, but 663 million people still live without. Other recent work demonstrates that 4 billion people annually face severe water scarcity as a result of seasonal fluctuations in water availability and quality. How is it that, despite the significant development in water resource availability documented by the UN, literally billions of people are regularly experiencing water insecurity? To begin to understand how a lack of access to reliable water resources affects everyday life, I focus on a specific outcome of water insecurity: waterborne illness. Given the difficulty in linking illness to a particular source, this research focuses on perceptions of water safety. I ask participants about illness they perceive coming from their drinking water, conducting face-to-face surveys (N = 224) spatially distributed around Choma town, Southern Province, Zambia. In particular, I investigate how these perceptions affect everyday life and what intersecting factors are likely to increase or decrease the probability of a person perceiving drinking water as the source of their illness. Our findings demonstrate that individual perceptions of waterborne illness are tightly coupled with perceptions of water needs being met or not, water flexibility (water storage capacity and water resource type and number available), total water use, food security and distance to various services. My work identifies and qualifies intersecting relationships that are critical to the design of any policy or other means of intervention intended to reduce experienced and perceived waterborne illness and other everyday needs of subsistence farmers facing the challenges presented by climate change and other forms of environmental change.

Structural Vulnerability Associated with Radiation Treatment Gaps in Head and Neck Cancer Patients

Social determinants of health influence access to cancer screening, treatment and outcomes. Structural vulnerability (SV) is defined as an individual’s risk for negative health outcomes due to socioeconomic, cultural, and institutional factors as related to ability to access care and adhere to recommended treatment. In head and neck cancer (HNC) patients, missed radiation therapy (RT) leads to worse survival. We hypothesized that increased SV correlated with impaired RT adherence. This was a prospective IRB-approved survey offered to all HNC patients scheduled for at least 5 continuous weeks of RT. The survey assessed 8 domains of SV: financial security, food access, social support, legal status, physical security, access to shelter, functional health literacy, and perceived discrimination. Clinical data were extracted from the chart. Logistic regression analysis was used to identify factors associated with SV, adjusted for resources provided to patients (i.e. transport, housing, food). A total of 62 patients consented; 2 declined. The median age was 62 (range 53-83). 35% of patients identified as non-white, and 20% spoke a non-English primary language. Patients received RT for cancers of the oropharynx, oral cavity, larynx, nasopharynx, skin, salivary gland and thyroid. 23 (37%) reported financial insecurity and 9 (15%) reported discrimination. 3 (5%) did not have a place to sleep, 6 (10%) felt unsafe in their home/neighborhood, 5 (8%) did not have adequate food, 8 (13%) were without social support, 4 (6%) had legal concerns, and 12 (19%) had difficulty with medical documents. SV in any domain (p=0.006, OR 8.2, 95% CI 1.8-37.0) and the factor of financial insecurity (p=0.02, OR 5.2, CI 1.3-21.0) were significantly associated with ≥2 missed RT fractions. SV was associated with primary language other than English (p=0.007, OR 14.5, 95% CI 2.1-102). Patients with SV were 3.4 times more likely to miss fractions than those without SV, after adjusting for resources utilized (p=0.024, adjusted OR 3.4, 95% CI 1.2-9.9). This assessment reveals the multifaceted needs of our patients, beyond the purely financial, that threaten health outcomes. There are complex interplays of social hierarchy, power dynamics, and institutional policies that directly impact the health of our patients. Further study is needed to understand the impact of resources or services in mitigating these factors.

Socio-economic sustainable development and the precariat: a case study of three Russian cities

Sustainable social and economic processes of the recent decades are characterized by the emergence of new phenomenon known as precarity and its new accompanying class known as the precariat. The precariat as a social class or social community is primarily associated with a factor of instability and insecurity of workers with flexible employment. This paper studies the precarity on the labor market for the socially-oriented professions in the three Russian metropolitan areas: Moscow, Kazan, and Rostov-on-Don. The paper searches for the causes of precarity of socially-oriented professions based upon the analysis of economic processes in the public sector, and of the reformers' rhetoric and its reflection in the discourses of the main actors about the goals and direction of the reforms. Socially-oriented professions are associated with the creation of benefits, which are very little associated with markets and in most cases belong to public or mixed goods. Our findings suggest that the reforms of Russian education and healthcare spheres are accompanied by large-scale institutional changes which resulted in bureaucratization, orientation toward achieving performance indicators not related to professional values, stagnation of incomes, inequality between regions, and instability of professional trajectories. We conclude that reducing the prestige of socially-oriented professions, the material well-being, along with instability, become the main factors of precarity.

Assessing Livelihood Reconstruction in Resettlement Program for Disaster Prevention at Baihe County of China: Extension of the Impoverishment Risks and Reconstruction (IRR) Model

The paper develops a tool for livelihood recovery assessment in disaster-preventive resettlement. A new conceptual framework is built based on the impoverishment risks and reconstruction (IRR) model. This framework leads to a quantitative model that was designed and tested using the disaster resettlement preventive engineering (DRPE) project in Baihe county of China. The new model evaluates the qualities of livelihood recovery in terms of three components: Life reconstruction, development reconstruction, and safety reconstruction, which consider features specific to the Chinese society, and introduce a new insecurity factor. The model showed good reliability, validity, and sensitivity for the evaluation of livelihood reconstruction in disaster-preventive resettlement. Its application will help to target interventions to improve public services in resettlement areas by identifying cases with inadequately sustainable livelihoods.

The impact of job insecurity on long-term self-rated health \u2013 results from the prospective population-based MONICA/KORA study

BackgroundJob insecurity has been associated with impaired self-rated health (SRH) in cross-sectional studies, but prospective findings with short, medium and long-term follow-up yielded mixed findings. Therefore, the aim of the present study was to assess the long-term association between perceived job insecurity and SRH, after controlling for baseline levels of health status and life-style choices. Furthermore, three different follow-up periods (14, 19 and 24 years) were considered.MethodsData were derived from the prospective population-based MONICA/KORA cohort study (southern Germany). N = 4356 participants (2622 men and 1734 women), aged between 25 and 64 years at baseline, were included in the sample, mean follow-up was after 19.1 years. Job insecurity, SRH and risk factors were assessed at baseline during three independent surveys (1984–1995). SRH was additionally assessed in 2009. The association of job insecurity and impaired SRH at follow-up was estimated using logistic regression analyses.ResultsOverall, perceiving job insecurity at baseline was significantly associated with a 20% higher risk of developing impaired SRH at follow-up in the pooled analysis (OR = 1.20, 95% CI = 1.01–1.43, p = .034), even after controlling for baseline SRH, socio-demographic characteristics, lifestyle, clinical and work-related factors. The association was strongest and significant after 14 years (OR = 1.58, 95% CI 1.17–2.13, p = .003) and weaker and not significant to 19 (OR = 1.20, 95% CI 0.89–1.62, p = .24) and 24 years (OR = 0.98, 95% CI 0.73–1.32, p = .89) of follow-up in the fully adjusted models.ConclusionsWe found that perceived job insecurity during working life was independently and significantly associated with impaired SRH both cross-sectionally as well as after 14 years, but not after 19 and 24 years.

Food acquisition methods and correlates of food insecurity in adults on probation in Rhode Island.

BackgroundIndividuals under community corrections supervision may be at increased risk for food insecurity because they face challenges similar to other marginalized populations, such as people experiencing housing instability or substance users. The prevalence of food insecurity and its correlates have not been studied in the community corrections population.MethodsWe conducted a cross-sectional study in 2016, surveying 304 probationers in Rhode Island to estimate the prevalence of food insecurity, identify food acquisition methods, and determine characteristics of groups most at-risk for food insecurity. We used chi-square and Fisher’s exact tests to assess differences in sociodemographics and eating and food acquisition patterns, GIS to examine geospatial differences, and ordinal logistic regression to identify independent correlates across the four levels of food security.ResultsNearly three-quarters (70.4%) of the participants experienced food insecurity, with almost half (48.0%) having very low food security. This is substantially higher than the general population within the state of Rhode Island, which reported a prevalence of 12.8% food insecurity with 6.1% very low food security in 2016. Participants with very low food security most often acquired lunch foods from convenience stores (and less likely from grocery stores) compared to the other three levels of food security. Participants did not differ significantly with regards to places for food acquisition related to breakfast or dinner meals based upon food security status. In adjusted models, being homeless (AOR 2.34, 95% CI: 1.31, 4.18) and depressed (AOR 3.12, 95% CI: 1.98, 4.91) were independently associated with a greater odds of being in a food insecure group. Compared to having help with meals none of the time, participants who reported having meal help all of the time (AOR 0.28, 95% CI: 0.12, 0.64), most of the time (AOR 0.31, 95% CI: 0.15, 0.61), and some of the time (AOR 0.54, 95% CI: 0.29, 0.98) had a lower odds of being in a food insecure group. Food insecure participants resided in different neighborhoods than food secure participants. The highest density of food insecure participants resided in census tracts with the lowest median incomes for the general population. The areas of highest density for each level of food security for our participants were in the census tracts with the lowest levels of full-time employment for the general population.ConclusionsThe prevalence of food insecurity and very low food security were markedly higher in our probation population compared to the general RI population. These findings suggest that access to food on a regular basis is a challenge for adults on probation. Depression and being homeless were independently associated with a greater odds of being in a food insecure group. In addition to intervening directly on food insecurity, developing interventions and policies that address the contributing factors of food insecurity, such as safe housing and treatment for depression, are critical.

Household Food Insecurity and Hunger in Selected Ethiopian Agricultural Communities: Examination of Supply and Demand Factors

Food insecurity and hunger are major challenges in many Ethiopian communities with repercussions on health and nutrition outcomes in vulnerable household members. The level and contextual risk factors of household food insecurity and hunger were assessed in households (n=630) from three rural communities of Ethiopia (Halaba or Zeway) using the Household Food Insecurity Access Scale and Household Hunger Scale. Multiple classification analysis was employed to explore the effects of key demand (e.g. household size, livestock) and supply (e.g. land size, frequency of production) factors and community (geographic location) as well as institutional (participation in food security programs) factors on food insecurity and hunger. Household food insecurity was unacceptably high in both districts (95% in Halaba &amp;amp; 67% in Zeway). Household hunger was 38% in Halaba and 18% in Zeway. Both food insecurity and hunger were significantly greater in Halaba (p&amp;lt;0.001), indicating an effect of geographic location. Both supply and demand factors were significant in determining household food insecurity and hunger (p&amp;lt;0.01); however, supply factors such as women’s access to land, land size and wealth had greater influence than the demand factors. Levels of food insecurity and hunger in both communities were very high and of serious concern. We recommend increasing the food supply, and its subsequent accessibility, for households through enhancing women’s access to land, improving income through savings and wealth accumulation, introducing more inclusive programs for women’s participation and reducing household work-burden by significantly enhancing productivity of cultivable land.

Pengaruh Kompensasi dan Job Insecurity Terhadap Turnover Intention Pada Buruh di Kabupaten Kudus (Studi Kasus Pada PT. Pura Barutama Unit Offset Divisi Produksi)

Human resources is an important factor in the company as it can support the achievement of goals in the company. Hence, the company must maintain human resources in order not to leave the company and find work in other companies. So to suppress human resources especially laborers out of the company (turn over intention) the company should pay attention to the factors that support turnover intention, including compensation and job insecurity factors. This study aims to determine the effect of compensation and job insecurity on turnover intention in the case study at PT. Pura Barutama Unit Offset Production Division. This type of research using explanatory research and sampling technique using a non-probability sampling technique with purposive sampling method, data collection technique using the questionnaire method. Thenumber of samples used in this study as many as 100 respondents. This research uses quantitative and qualitative analysis with validity test, reliability test, correlation coefficient, the coefficient of determination, simple regression and multiple tests, and significance of T and F test. The results of this study indicate that the compensation and job insecurity variables have a strong influence on turnover intention variables. The compensation variable has a strong influence as well as the direction of a negative relationship to the turnover intention variable. While job insecurity variables have a very strong influence and have a positive relationship direction to the variable turnover intention.

Abstract P303: Racial Differences in the Associations Between Food Insecurity and Fibroblast Growth Factor 23 (FGF23) in The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Elevated Fibroblast Growth Factor 23 (FGF23) - an endocrine hormone linked to cardiovascular and kidney disease outcomes - is a compensatory response to high dietary phosphate load or chronic kidney disease. Large quantities of inorganic phosphates additives are found in processed foods, and food insecurity is associated with higher consumption of processed foods. Hypothesis: We hypothesized that developing food insecurity is associated with an increase in FGF23. Methods: We included CARDIA study participants with a stored plasma sample available from at least two consecutive exams at years 20, 25, and 30 (N=3,421). Food insecurity was assessed through a single question about ability to afford quantity and quality of food. FGF23 levels were assessed using a commercial c-terminal ELISA. Due to a strong right skew in FGF23 levels, we divided FGF23 in quartiles and compared the highest quartile to the combined lower three quartiles using logistic regression. Econometric fixed effects models that adjust by design for all time-invariant covariates were used to model the longitudinal association between simultaneous within-person change in food insecurity and FGF23. Due to an interaction between food insecurity and race ( p =0.002), we stratified by race. Results: About 29% of blacks and 14% of whites experienced change in food insecurity during follow-up. Developing food insecurity was associated with a 1.46 greater odds of increasing to the highest quartile of FGF23 (95% CI: 1.02,2.10) among blacks; however, there was no significant longitudinal association among whites (OR=1.05; 95% CI: 0.62,1.77). Conclusions: Using models that tightly control for all time-invariant confounding, we found that developing food insecurity was associated with increases in FGF23 among blacks. The differential increases in blacks as compared to whites may be due to differences in dietary changes in response to developing food insecurity. Previous research has shown racial differences in dietary quality by food insecurity.