Food-insecure Participants Research Articles

Food Insecurity Among University Students at a German University: Impact on Health, Academic Performance, and Lifestyle During COVID-19

ABSTRACT Studies show that university students, especially food insecure students, were often negatively affected by the COVID-19 pandemic. For Germany, no data covers this time period, differentiating between food security statuses. We conducted a cross-sectional online survey (n = 562) between November and December 2021 at the Justus Liebig University Giessen, Germany, using the validated Food Insecurity Experience Scale to assess food (in)security. Our results affirm changes in academic performance, health and eating habits during the pandemic, with food insecure participants being more negatively affected. Preventive measures are needed to mitigate the adverse effects of crises, targeting all, but especially food insecure university students.

Evaluation of a Food as Medicine Program in Southeastern U.S.: Perspectives by Food Insecure Participants with Uncontrolled Diabetes and Hypertension and Program Providers

Evaluation of a Food as Medicine Program in Southeastern U.S.: Perspectives by Food Insecure Participants with Uncontrolled Diabetes and Hypertension and Program Providers

Nutrition literacy and eating habits in children from food-secure versus food-insecure households: A cross-sectional study.

This study aimed to explore whether maternal food and nutrition literacy (FNL) can mitigate negative effects of food insecurity on children's eating habits and assist food-insecure households in making better nutrition choices with limited resources available. A cross-sectional study was conducted on children aged 6 to 12 years and their mothers. FNL was assessed using a validated Food and Nutrition Literacy Assessment Tool, and household food security was evaluated with the Household Food Insecurity Access Scale. Eating habits were measured through a structured questionnaire that focused on various dietary habits. Logistic regression was used to determine the associations between maternal FNL, food insecurity status, and children's eating habits. A total of 327 children-mothers, comprising 159 food-secure and 168 food-insecure households, were evaluated. Maternal FNL was inversely associated with consumption of fast-foods and fried foods, and skipping breakfast in both food-secure and food-insecure participants. However, only food-secure participants showed an inverse association between FNL and the habit of eating out. Both groups indicated lower sweet consumption associated with higher FNL. Maternal FNL was inversely associated with lower dairy and nut intake in food-secure group and lower fruit and vegetable consumption in food-insecure participants. This study suggests that in conditions of food insecurity FNL may reduce the negative impact of food insecurity on children's nutrition choices and food habits.

Food Insecurity in Hispanic Populations Is Associated with an Increased Risk of Hepatic Steatosis: A Nationally Representative Study.

Introduction: The Hispanic population in the US faces a higher risk of nonalcoholic fatty liver disease (NAFLD). Multiple factors influence this risk, including genetics, environmental factors, and socioeconomic statuses. Inadequate access to nutritious foods, or food insecurity, is prevalent among Hispanic individuals and poses a metabolic risk for both the onset and development of NAFLD. Materials and Methods: We utilized the National Health and Nutrition Examination Survey (NHANES) 2017-2020 pre-pandemic data to analyze the association between Hispanic ethnicity, hepatic steatosis, fibrosis, and food insecurity. Vibration-controlled transient elastography (VCTE) was employed to assess liver stiffness (LSM) and controlled attenuation parameter (CAP) scores to determine fibrosis and steatosis, respectively. Linear and ordinal logistic regression models were applied to their continuous, log-transformed, and categorical forms, adjusting for demographics, metabolic comorbidities, and socioeconomic factors. Models were subsequently stratified based on food security statuses. Results: A total of 7396 Hispanic participants were included in the study. Under multivariable analysis, Hispanic individuals had higher CAP scores (Beta-coefficient: 10.2 dB/m, 95% CI: 6.1-14.4 dB/m, p = 0.001)) vs. non-Hispanic individuals, without statistically significant differences in fibrosis. Food-insecure participants exhibited higher CAP scores than their food-secure counterparts. After stratification, a stronger association between Hispanic ethnicity and CAP scores was evident in the food-insecure group (Beta-coefficient: 11.8 dB/m, 95% CI: 4.4-19.3 dB/m, p = 0.003). Discussion: This study demonstrates the heightened risk of hepatic steatosis among individuals with Hispanic ancestry in the US. The risk is exacerbated by food insecurity, particularly for Hispanic individuals. The contribution is linked to the dietary habits in this population that lead to metabolic risk factors associated with hepatic steatosis. Considering the rising prevalence of NAFLD and food insecurity, interventions focusing on nutritional support and healthcare access among this population could mitigate these burdens.

Community-Based Designed Pilot Cooking and Texting Intervention on Health-Related Quality of Life among College Students.

As emerging adulthood is an important area of life for developing healthful habits, the current study aimed to test the feasibility of a pilot program for improving health-related quality of life (HRQOL), food security, and diet quality among college students. Students 18-26 years old were recruited from two land-grant institutions to participate in an online survey and self-selected to participate in an intervention study. An intervention program was developed by student peers to include (1) a four-session cooking curriculum and a (2) semester-long text message program to share health resources on the relevant college campus. Diet quality, food security, and mentally healthy days were assessed. Baseline to post-program changes were assessed using paired t-tests. Cohen's d was used to determine effect size estimates. In the full sample (N = 65), "days/month when mental health was not good" and "days/month feeling worried, tense, or anxious" significantly improved (p < 0.05). Dietary quality measures of total short Healthy Eating Index (sHEI) score and total vegetable intake significantly improved throughout the intervention. Subsamples of (1) food-insecure participants (n = 22) and those with (2) dietary quality below the 50th percentile (n = 29) both had positive improvements following the program. Health promotion programs should be formed, adapted, or expanded in an effort to improve health among our next generation of workers. College and university environments should focus on mental health, diet, and food security among their constituents, particularly with regard to those at risk.

Food insecurity is associated with a higher body mass index and lower albumin levels in patients with congestive heart failure in the All of Us research program

Abstract Introduction Congestive Heart Failure (CHF) is an extremely prevalent disorder worldwide with high morbidity and mortality rates. Estimates suggest that approximately 80% of cardiovascular diseases (CVD), including CHF, can be prevented by controlling risk factors and adopting a healthy lifestyle. However, there are substantial barriers to implementing this guidance for many patients, including food insecurity, which is a household-level economic and social condition of limited or uncertain access to adequate food. Food insecurity is also associated with a greater prevalence of overweight and obesity, which plays a role in the pathogenesis of CHF. Purpose Our goal is to examine the difference in body mass index (BMI), nutritional and cardiac-specific markers—specifically albumin, B-type natriuretic peptides (BNP), N-terminal pro-B-type natriuretic peptides (NT-proBNP), and troponin I (TnI)—between patients with CHF who are food secure and patients with CHF who are food insecure. To our knowledge, no prior studies have examined this important relationship in a large population-based sample. Methods We use the All of Us Research Program (AoURP) to analyze a large cohort of 372,380 participants representing the diversity of the US population in terms of ancestry, demographics, socioeconomic status, and other characteristics. Of the 372,380 participants, 12,529 had CHF, of which 1472 answered the two validated screening questions for food insecurity, also known as the "hunger vital sign". We split the CHF participants between a food-secure group (1297 participants) and a food-insecure group (175 participants), where food security is defined as responding "never" to both questions of the "hunger vital sign". Results Our findings indicate that the food insecure participants are younger (p&amp;lt;0.0001), less likely to drink alcohol (p&amp;lt;0.0001), less educated (p&amp;lt;0.0001), and more likely to be black (p&amp;lt;0.0001), female (p&amp;lt;0.0001), and Hispanic (p&amp;lt;0.001). The mean (+-SD) BMI for the food insecure group is 35.0 (+-8.8) kg m-2 compared to 31.3 (+-7.2) kg m-2 for the food secure group (p&amp;lt;0.00001) and the mean (+-SD) albumin level for the food insecure group is 34.2 (+- 2.9) g/L compared to 38.4 (+-4.2) g/L for the food secure group (p&amp;lt;0.0001). The differences in BNP, NT-proBNP, and TnI are not statistically significant. Conclusion Our findings–demographic differences, higher mean BMI, lower albumin levels in CHF patients who are food insecure–indicate the necessity to reevaluate our approach to care for historically underserved patients.

Associations among eating behaviors, food security status, and dietary intake during pregnancy

Dietary intake of certain food groups and/or nutrients during pregnancy has been associated with maternal and infant pregnancy-related outcomes. Few studies have examined how behavioral and environmental factors interact to influence prenatal diet. We examined associations between eating behaviors (dietary restraint, emotional eating, external eating) and food security status regarding dietary intake of selected nutrients/food groups during pregnancy. Participants (N = 299; 29% Non-Hispanic Black; 16% ≤ high school education; 21% food insecure) completed validated questionnaires to assess estimated daily intake of food groups/nutrients during pregnancy [e.g., added sugars from sugar-sweetened beverages (SSBs), % of energy from fat, fruit and vegetable (FV) intake] via National Cancer Institute Dietary Screener Questionnaires); eating behaviors (Dutch Eating Behavior Questionnaire); and food security status (6-item USDA Food security Module). Separate hierarchical multiple regressions for each dietary outcome were conducted controlling for maternal age, education, income-to-needs, race/ethnicity, pre-pregnancy BMI, and gestational diabetes. A significant interaction was found between dietary restraint and food security status on added sugar intake from SSBs (β = −0.15, p = 0.02). The negative association between restraint and added sugar from SSBs was stronger among food insecure participants (β = −0.47, p < 0.001 vs. β = −0.15, p = 0.03). Higher external eating (β = 0.21, p < 0.01) and lower restraint (β = −0.13, p = 0.03) were associated with higher % of energy from fat and living in a food insecure household (β = −0.15, p = 0.01) was associated with lower FV intake. Understanding dietary intake during pregnancy requires consideration of the broader context in which eating behaviors occur.

Food insecurity and depressive symptoms among young people living with HIV in Eastern Zambia.

Background: Mental health problems are common among people living with HIV/AIDS and contribute to poor HIV-related outcomes, including AIDS-related mortality. We examined the association between severe food insecurity and depressive symptoms in young people living with HIV (YPLH) in Zambia. Methods: We sampled 120 youth living with HIV aged 18-21years in the Eastern Province of Zambia. Household food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS). Mental health was assessed using the Children's Depression Inventory-Short Form. We fitted linear regression models to assess whether food insecurity is associated with depressive symptoms. Results: The mean age was 19years, and 63% were female. Overall, 43% were severely food insecure. After adjusting for sociodemographic variables and other confounders, severely food insecure participants were more likely to report depressive symptoms (β = 0.81, 95% Confidence Interval [CI] 0.07-1.55) and engagement in sex work (β = 1.78, 95% CI 0.32-3.25). Conclusion: Almost half of the sample reported severe food insecurity which was associated with depressive symptoms. Interventions aimed at improving food insecurity may have beneficial effects on mental health and HIV outcomes among young people living with HIV in resource-limited settings.

Food Insecurity Is Associated With Urge Urinary Incontinence: An Analysis of the 2005-2010 National Health and Nutrition Examination Survey.

Urge urinary incontinence is the involuntary leakage of urine associated with a sudden compelling urge to void. A previous study found an association between urge urinary incontinence and household income, indicating that social determinants of health may influence urge urinary incontinence. Food insecurity is a relevant social determinant of health, as a diet with bladder irritants may worsen urge urinary incontinence symptoms. This study aimed to investigate the association between urge urinary incontinence and food insecurity. We collected data from the 2005-2010 cycles of the National Health and Nutrition Examination Survey, a nationally representative health survey administered by the Centers for Disease Control and Prevention. The association between urge urinary incontinence and food insecurity was analyzed using survey-weighed logistic regression with adjustments for demographic, socioeconomic status, behavioral, and medical comorbidities covariates. We included 14,847 participants with mean age 50.4±17.9 years; 22.4% of participants reported at least 1 episode of urge urinary incontinence. We found that participants who reported food insecurity had 55% greater odds of experiencing urge urinary incontinence compared to those who have not (OR=1.55, 95% CI=1.33-1.82, P < .001). When comparing diets, food-insecure participants reported significantly less intake of bladder irritants (caffeine and alcohol) compared to food-secure participants. When the sample was stratified by food insecurity status (yes vs no), consumption of caffeine did not differ by urge urinary incontinence status and consumption of alcohol was lower among participants with vs without urge urinary incontinence. Adults reporting food insecurity in the past year are significantly more likely to experience urge urinary incontinence than those who did not. Consumption of bladder irritants including caffeine and alcohol was significantly less in food-insecure compared to food-secure participants. When the sample was stratified by food insecurity status (yes vs no), consumption of caffeine did not differ by urge urinary incontinence status and consumption of alcohol was lower among participants with vs without urge urinary incontinence. These data indicate that diet alone does not drive the association between urge urinary incontinence and food insecurity. Instead, food insecurity may be a proxy for social inequity, perhaps the greatest driver of disease.

Outcomes of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention.

Diabetes self-management education and support is the cornerstone of diabetes care, yet only 1 in 2 adults with diabetes attain hemoglobin A1c (HbA1c) targets. Food insecurity makes diabetes management and HbA1c control more difficult. Our aim was to test whether a cooking intervention with food provision and diabetes self-management education and support improves HbA1c and diabetes management. This was a waitlist-controlled, randomized trial. Participants were 48 adults with type 1 or type 2 diabetes. Cooking Matters for Diabetes was adapted from Cooking Matters and the American Diabetes Association diabetes self-management education and support intervention into a 6-week program with weekly food provision (4 servings). Surveys (ie, Summary of Diabetes Self-Care Activities; Medical Outcomes Study Short Form Health Survey, version 1; Diet History Questionnaire III; 10-item US Adult Food Security Survey Module; and Stanford Diabetes Self-Efficacy Scale) were administered and HbA1c was measured at baseline, post intervention, and 3-month follow-up. Mixed-effects linear regression models controlling for sex and study wave were used. Mean (SD) age of participants was 57 (12) years; 65% identified as female, 52% identified as White, 40% identified as Black, and 19 (40%) were food insecure at baseline. Intervention participants improved Summary of Diabetes Self-Care Activities general diet score (0 to 7 scale) immediately post intervention (+1.51; P= .015) and 3 months post intervention (+1.23; P= .05), and improved Medical Outcomes Study Short Form Health Survey, version 1, mental component score (+6.7 points; P= .025) compared with controls. Healthy Eating Index 2015 total vegetable component score improved at 3 months (+0.917; P= .023) compared with controls. At baseline, food insecure participants had lower self-efficacy (5.6 vs 6.9 Stanford Diabetes Self-Efficacy Scale; P= .002) and higher HbA1c (+0.77; P= .025), and demonstrated greater improvements in both post intervention (+1.2 vs+0.4 Stanford Diabetes Self-Efficacy Scale score; P= .002, and -0.12 vs+0.39 HbA1c; P= .25) compared with food secure participants. Cooking Matters for Diabetes may be an effective method of improving diet-related self-care and health-related quality of life, especially among food insecure patients, and should be tested in larger randomized controlled trials.

Exploring dimensions of social capital in relation to healthy eating behaviours in the US rural south.

This study examined relationships between dimensions of social capital (SC) (social trust, network diversity, social reciprocity and civic engagement) and fruit, vegetable, and sugar-sweetened beverage (SSB) consumption among rural adults. Potential moderators (neighbourhood rurality, food security, gender and race/ethnicity) were explored to develop a more nuanced understanding of the SC-healthy eating relationship. Data were from a 2019 mailed population-based survey evaluating an eleven-county initiative to address health equity. Participants self-reported health behaviours, access to health-promoting resources and demographics. Logistic regression models were used to analyse relationships between predictors, outcomes and moderators. Five rural counties, Georgia, USA. 1120 participants. Among participants who lived in the country (as opposed to in town), greater network diversity was associated with consuming ≥ 3 servings of fruit (OR = 1·08; 95 % CI 1·01, 1·17, P = 0·029), yet among participants who lived in town, greater civic engagement was associated with consuming ≥ three servings of fruit (OR = 1·36; 95 % CI 1·11, 1·65, P = 0·003). Both food-secure and food-insecure participants with greater social reciprocity had lower odds of consuming 0 SSB (OR = 0·92; 95 % CI 0·86, 0·98, P = 0·014, OR = 0·92; 95 % CI 0·86, 0·99, P = 0·037, respectively). Men with greater social trust were more likely to consume 0 SSB (OR = 1·09; 95 % CI 1·01, 1·18, P = 0·038), and Whites with greater network diversity were more likely to meet daily vegetable recommendations (OR = 1·10; 95 % CI 1·01, 1·19, P = 0·028). Findings provide a basis for future qualitative research on potential mechanisms through which SC and related social factors influence healthy eating in rural communities.

Food as Medicine Clinic: Early Results and Lessons Learned.

Hospital-based food pantries are commonly used to address food insecurity. However, few studies have examined the impact of these food pantries on patients with chronic health conditions. In this study, we sought to assess the effect of a hospital-based food pantry clinic on self-reported dietary changes, health outcomes, and resource utilization. This study included food insecure participants with suboptimally controlled congestive heart failure, hypertension, or diabetes who visited a Food as Medicine (FAM) clinic at an academic healthcare system between October 2018 and November 2019. The clinic provided a three-day supply of food for participants and their families up to two times per month for up to 12 months. Baseline, three-month, and six-month surveys were used to assess dietary behaviors, and electronic health record (EHR) data were used to assess health outcomes and utilization. Multivariable Poisson regression was used to explore variables associated with FAM clinic use. At three months, participants self-reported improved dietary behaviors, including increased consumption of fruits and vegetables as snacks and an increased variety of fruits and vegetables consumed. There were no statistically significant changes in clinical or healthcare utilization measures, despite small absolute improvements in systolic blood pressure (SBP), hospitalizations, and emergency department (ED) visits. There was a weak association between FAM clinic visit frequency and changes in dietary behaviors. Among patients with chronic diseases, the use of the FAM clinic was associated with improved self-reported dietary behaviors and a nonsignificant improvement in health outcomes and resource utilization.

Changes in Food Insecurity Among Individuals Using a Telehealth and Nutrition Platform: Longitudinal Study.

Food insecurity is a complex public health problem affecting many individuals in the United States. Digital health interventions that promote behavior change and provide access to affordable and healthy food may help to alleviate food insecurity. The aim of this study was to characterize food-insecure users of Foodsmart, a telehealth and nutrition platform with meal planning, food ordering, nutrition education, budgeting, and grocery discount features, and to evaluate changes in diet and food insecurity. We retrospectively analyzed data collected from 4595 adults who used the Foodsmart platform between February and October 2021. Participants self-reported their diet, demographics, biometrics, and food insecurity status in a 56-item questionnaire. Participants were reported to be food insecure if they answered "sometimes" or "often" to the question "How often does the food you buy not last and you don't have money to get more?" from the United States Department of Agriculture's Household Food Security survey. We examined baseline characteristics of participants by food insecurity status, associations between characteristics and baseline food insecurity, and changes in diet quality and food insecurity status. To evaluate potential causes of reversing food insecurity, the use of 6 Foodsmart features was compared between food-insecure participants who achieved food security versus food-insecure participants who remained food insecure, based on their last response to the food insecurity question. We found that 16% (742/4595) of participants were food insecure at baseline. Participants who were food insecure at baseline were more likely to be obese, to have at least one chronic condition, to have a lower diet quality, to cook less frequently at home, to think healthy food is too expensive, and less likely to order takeout or eat at a restaurant. Among participants who were food insecure at baseline, 61% (451/742) improved their nutrition and 29% (217/742) responded that they were food secure at follow-up, with an increasing percentage achieving food security with longer enrollment time. Using a multivariable logistic regression model, we found that age, diabetes, prediabetes, BMI categories, and diet quality at baseline were statistically significantly associated with the likelihood of being food insecure at baseline. Among those who were food insecure at baseline, there was a higher relative proportion of participants who achieved food security and used the "deals" (28.6% higher), "CookItNow" (36.4% higher), and "telenutrition" (27.5% higher) features compared to those who remained food insecure. This study assesses the characteristics of individuals enrolled on the Foodsmart platform who answered the food insecurity question. We found that a significant number of participants who were food insecure at enrollment achieved food security. This finding shows that telehealth and nutrition platforms may potentially help users improve household food security.

Prevalence of household food insecurity and its predictive role on the health of mothers with children aged under 60 months.

Food insecurity can have poor physical and mental health consequences for all family members. The present study investigated the prevalence of household food insecurity and its predictive role on the health of mothers of children aged under 60 months in Qazvin (Iran). A cross-sectional study was carried out between January 2019 and December 2020. Participants included all mothers with children aged under 60 months who referred themselves to comprehensive health centers in Qazvin (N=1750; mean age 30.61 years). Convenience sampling was performed. Data were collected using a demographic information checklist, the General Health Questionnaire (GHQ) and the Household Food Insecurity Access Scale (HFIAS). Data analysis was performed using independent t-tests, one-way analyses of variance, uni-variable and multivariable linear regression with a significance level of p<0.05. Two-thirds of the participants had a secure food status (68.4%). Household food security status showed a significant, and inverse relationship with general health subscales. General health subscales of depression (standardized mean difference or SMD:-1.24 [95% CI:-1.36;-1.13]), somatic symptoms (SMD:-0.92 [95% CI:-1.03;-0.81]) and anxiety and insomnia (SMD:-0.72 [95% CI:-0.83;-0.61]) were significantly lower among food secure participants vs. food insecure participants. Social dysfunction was not significantly associated with household food security. The regression models demonstrated that household food security was a significant predictor for the health of mothers with children aged under 60 months: uni-variable (β=-0.38) and multivariable (β=-0.41). Household food security is associated with various aspects of mothers' health. Since the growth and development of a healthy child depends on having a healthy mother, the food security situation of the family and the general health of mother can be assessed as part of providing health service regarding monitoring growth and development of children. This will help in targeting appropriate interventions if needed.

The association of food insecurity and cardiometabolic risk factors was independent of body mass index in Iranian women

BackgroundInvestigations on food insecurity have shown that food insecurity is inversely associated with health. We examined the association of food insecurity and cardiometabolic risk factors in women living in Shiraz, Iran.MethodsThe cross-sectional study was performed on 190 females. Food insecurity was assessed by Household Food Insecurity Access Scale. Cardiometabolic risk factors including anthropometric characteristics, blood pressure, and serum glucose and lipids were measured. Metabolic syndrome score was calculated according to the criteria described for Iranian adults. The association of food insecurity and cardiometabolic risk factors was assessed by linear regression.ResultsThe prevalence of food security, and mild, moderate, and severe food insecurity was 42.6%, 40.5%, 15.8%, and 1.1%, respectively. Cardiometabolic risk factors worsened with increasing severity of food insecurity. Among the risk factors, body mass index (BMI) had the strongest association with food insecurity. After controlling demographic factors and BMI, fasting blood glucose, triglycerides, total, LDL, and HDL cholesterols, and metabolic syndrome score still showed significant associations with food insecurity (P < 0.01) but systolic and diastolic blood pressure were no longer associated with food insecurity after adjustment for BMI.ConclusionOverall, although BMI was strongly associated with food insecurity, cardiometabolic risk factors including blood glucose, triglycerides, total, HDL, and LDL cholesterols, and metabolic syndrome score were associated with food insecurity independent of BMI, suggesting that other factors such as lifestyle and diet may have contributed to the exacerbated cardiometabolic risk in food insecure participants of this study. Future studies need to clarify underlying factors in the association of food insecurity and cardiometabolic risk factors.

Food insecurity and physical functioning in Boston area Puerto Rican older adults

AbstractObjective:Prior studies have found evidence of a relationship between food insecurity and functional limitations among older populations in the USA.Design:This is a longitudinal investigation of food security in relation to functional limitations, assessed as Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores.Setting:The Greater Boston, MA area.Participants:1461 Boston Puerto Rican Health study participants, predominantly (70·5 %) female and aged 57·1 years (sd ± 7·6) at baseline followed for 6·2 (sd ± 0·98) years.Results:In cross-sectional analysis at baseline, participants reporting severe food insecurity had greater functional limitations (higher ADL; β = 2·34; 95 % CI (1·48, 3·19)) and higher IADL (β = 1·17, 95 % CI (0·68, 1·65)) compared with food secure participants. In longitudinal linear mixed models, severely food insecure participants at baseline had greater functional limitations over 5 years, as assessed by ADL (β = 1·74; 95 % CI (0·95, 2·53); P &lt; 0·001) and IADL (β = 0·93, 95 % CI (0·48, 1·38)) compared with food secure participants. However, baseline food security did not significantly alter the 5-year trajectory in ADL (P-interaction between baseline food security and time for ADL and IADL = 0·41 and 0·47, respectively).Conclusions:In this cohort of Boston area Puerto Rican adults, those who are food insecure had consistently higher ADL and IADL scores over time, compared with those who are food secure. Baseline food security did not appear to alter the trajectory in ADL or IADL score.

Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity.

BackgroundLebanon is undergoing multiple overlapping crises, affecting the food security, financial well-being, and quality of life (QOL) of its residents.ObjectiveThe primary objective was to assess the food insecurity (FI) status of a sample of the Lebanese population. The second objective was to explore factors related to QOL parameters and evaluate the mediating effect of food security between financial well-being and QOL.MethodsThe study was cross-sectional and enrolled 412 participants recruited online using the snowball sampling technique. The survey included questions related to sociodemographic and economic characteristics of Lebanese households and validated scales to assess FI, QOL measures, financial well-being, and fear of COVID-19.ResultsAlmost 43% of the study participants reported being food insecure, with 31% experiencing mild FI, 10% moderate FI, and 1.5% severe FI. Compared to food-insecure participants, food secure participants had a significantly higher income (58.5% vs. 39.2%, p < 0.001), a university education level (96.6% vs. 88.1%, p = 0.002), an average perceived financial status (83.9% vs. 65.9%), higher financial well-being scores (5.14 vs. 3.19, p < 0.001), and lower crowding index (0.94 ± 0.4 vs. 1.09, p = 0.002). Multivariate analysis showed that FI was not associated with physical (Beta = −1.48, 95% CI: −3.10; 0.13) and mental (Beta = −1.46, 95% CI −3.68; 0.75) QOL, after adjusting for other demographic and socioeconomic correlates. This association remained non-significant when introducing the financial well-being variable to the model. Mediation analyses showed that the FI variable mediated the association between financial well-being and physical QOL (Beta = 0.19, 95% CI: 0.02; 0.36), but not the mental QOL (Beta = −0.02, 95% CI: −0.20; 0.14).ConclusionFood insecurity was prevalent in our study sample, and it mediated the association between financial well-being and physical, but not mental, QOL parameters. These findings call for evidence-based policies and programs to help improve the food security and well-being of Lebanese households amidst these unprecedented circumstances.

Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada.

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.

Associations Between Food Literacy and Food Insecurity Among College Students in Lebanon: A Cross-Sectional Study

ObjectivesThe present study aims to explore the eating and food literacy behaviours of college students in Lebanon and to examine their associations with food insecurity (FI). MethodsAn online survey was administered among college students enrolled in public and private universities in Lebanon. FI was assessed using the Food and Drug Administration (FAO) eight-item Food Insecurity Experience Scale (FIES), previously validated and used in this context. The eating and food literacy behaviors of college students were assessed using the Eating and Food Literacy Behaviors (EFLBQ) tool. Multiple logistic regression analyses were conducted to investigate the associations of food literacy behaviors with FI. ResultsFI was reported among 39% of study participants. Approximately half of college students in the study sample reported that they “never” or “seldom” ate a balanced diet (55.6%) and consumed healthy food (47.7%). Less frequent food literacy behaviors reported among college students included: “select healthy foods “(37.5%)”, and” plan what I will eat” (33.2%). However, most college students do “often” or “always” eat foods convenient to them (82.9%) and prepare food made quickly (71.9%). Significant differences were observed in several food literacy behaviors between food secure and insecure students. For instance, food insecure students less frequently buy foods that are healthy (p < 0.001), select healthy foods (p = 0.004), cook healthy foods (p = 0.020) and choose nutritionally balanced meals (p < 0.001) compared to food secure ones. Multiple logistic regression analyses showed that behaviors related to nutrition and food preparation were all statistically independently associated with FI. Food insecure participants were significantly less likely to “choose nutritionally balanced meals (OR = 2.10, 95% CI:1.45,3.03), “read nutrition information before” (OR = 1.93, 95% CI:1.31,2.84), or “buy foods that are healthy” (OR = 1.87, 95% CI:1.26,2.78). In terms of food preparation, food insecure participants were 1.85 times more likely to report that they “never” or “seldom” accurately measure dry food ingredients when preparing food (OR = 1.85, 95% CI:1.30,2.64). ConclusionsFindings highlight the need for nutrition education interventions to improve food literacy and alleviate FI among college students in Lebanon. Funding SourcesAmerican University of Beirut.

Food Handling Concerns and Practices at Home during the COVID-19 Pandemic by Food Security Status

There is limited examination about coronavirus disease 19 (COVID-19)-related food handling concerns and practices that cause chemical or microbial contamination and illness, particularly among those with food insecurity. We investigated consumer food handling concerns and practices during the COVID-19 pandemic and whether they differed by food insecurity status. An online survey was distributed among Chicago, IL, residents between 15 July and 21 August 2020 (n = 437). Independent t tests and Fisher's exact tests were used to identify differences in food handling concerns and practices between those with and without food insecurity (alpha = 0.05). Survey items included questions about food handling practices that were considered safe or neutral (i.e., washing hands and produce with water, sanitizing food packaging) and unsafe (i.e., using cleaning agents to wash foods, leaving perishable foods outside) by using 5-point Likert-style scales or categorical responses (i.e., yes, no). Participant responses fell between "slightly" and "somewhat" concerned about contracting COVID-19 from food and food packaging (mean ± standard error [SE]: 2.7 ± 0.1). Although participants reported washing their hands before eating and before preparing foods at least "most of the time" (mean ± SE: 4.4 ± 0.0 and 4.5 ± 0.0, respectively), only one-third engaged in unsafe practices. The majority of participants (68%) indicated that they altered food handling practices due to the COVID-19 pandemic and received information about food safety from social media (61%). When investigating differences in concerns and practices by food insecurity status, food insecure participants were more concerned about COVID-19 foodborne transmission for all food items (all P < 0.001) and more frequently performed unsafe food handling practices than those with food security (all P < 0.001). Results from this study suggest more investigation is needed to understand barriers to safe food handling knowledge and practices, particularly among those with food insecurity.