Food-insecure Women Research Articles

Food Insecurity in an Urban Pregnancy Cohort.

Food insecurity is a prominent problem and has been implicated in adverse maternal and neonatal outcomes. This study aims to describe the food insecure population in an urban academic health center perinatal cohort. We enrolled 451 postpartum inpatients at the University of Cincinnati Medical Center who completed a questionnaire and were then categorized as food insecure based on U.S. Department of Agriculture standardized survey questions. Generalized linear models estimated the relative influence of maternal characteristics on food insecurity. Among the study population (n = 426), 18.6% (95% confidence interval: 15.2-22.4%) were classified as food insecure. Factors with increased adjusted relative risk on food insecurity include annual household income <$40,000, obesity, and smoking. Food insecure women also reported lower levels of love, satisfaction, and joy, and higher levels of despair. We recommend the use of a validated screening tool on all pregnant women with the associated psychosocial stressors and social determinants of health. · Food insecurity is prevalent among pregnant women.. · Nearly one in five women (18.6%) in the study cohort were classified as food insecure.. · Food insecure pregnant women were more likely to have additional risks for adverse health outcomes..

Higher Parity, Pre-Pregnancy BMI and Rate of Gestational Weight Gain Are Associated with Gestational Diabetes Mellitus in Food Insecure Women.

Food insecurity may exacerbate adverse maternal health outcomes during pregnancy, however, this association has not been well established, particularly in the context of developing countries. This study aimed to identify the associations between household food insecurity and gestational diabetes mellitus (GDM) risk among urban pregnant women. Household food insecurity was assessed using the translated 10-item Radimer/Cornell hunger scale. Logistic regression models were used to estimate the associations between food insecurity status and GDM risk. About 35.6% of women experienced food insecurity, with 25.2% reported household food insecurity, 8.0% individual food insecurity, and 2.4% child hunger. Food insecure women were at significantly higher risk of developing GDM compared to food secure women (AOR = 16.65, 95% CI = 6.17–24.98). The significant association between food insecurity and GDM risk was influenced by pre-pregnancy BMI, parity and rate of GWG at second trimester. Food insecure women with parity ≥ 2 (AOR = 4.21, 95% CI = 1.98–8.92), overweight/obese BMI prior to pregnancy (AOR = 12.11, 95% CI = 6.09–24.10) and excessive rate of GWG in the second trimester (AOR = 9.66, 95% CI = 4.27–21.83) were significantly more likely to develop GDM compared to food secure women. Food insecurity showed strong association with GDM risk in that the association was influenced by maternal biological and physical characteristics. Multipronged interventions may be necessary for food insecure pregnant women who are not only at risk of overweight/obesity prior to pregnancy but also may have excessive gestational weight gain, in order to effectively reduce GDM risk.

Food insecurity, diet quality and body composition: data from the Healthy Life Trajectories Initiative (HeLTI) pilot survey in urban Soweto, South Africa.

To determine whether food security, diet diversity and diet quality are associated with anthropometric measurements and body composition among women of reproductive age. The association between food security and anaemia prevalence was also tested. Secondary analysis of cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Food security and dietary data were collected by an interviewer-administered questionnaire. Hb levels were measured using a HemoCue, and anaemia was classified as an altitude-adjusted haemoglobin level < 12·5 g/dl. Body size and composition were assessed using anthropometry and dual-energy x-ray absorptiometry. The urban township of Soweto, Johannesburg, South Africa. Non-pregnant women aged 18-25 years (n 1534). Almost half of the women were overweight or obese (44 %), and 9 % were underweight. Almost a third of women were anaemic (30 %). The prevalence rates of anaemia and food insecurity were similar across BMI categories. Food insecure women had the least diverse diets, and food security was negatively associated with diet quality (food security category v. diet quality score: B = -0·35, 95 % CI -0·70, -0·01, P = 0·049). Significant univariate associations were observed between food security and total lean mass. However, there were no associations between food security and body size or composition variables in multivariate models. Our data indicate that food security is an important determinant of diet quality in this urban-poor, highly transitioned setting. Interventions to improve maternal and child nutrition should recognise both food security and the food environment as critical elements within their developmental phases.

Perceived Neighborhood-Level Drivers of Food Insecurity Among Aging Women in the United States: A Qualitative Study

BackgroundAging populations in the United States exhibit high rates of food insecurity and chronic illness. Few studies have explored the neighborhood-level drivers of food insecurity among such populations, and how they intersect with experiences of aging. ObjectiveThe aim of this study was to explore how aging women experience food insecurity in the United States, and the neighborhood-level factors that influence these experiences. DesignSemistructured qualitative interviews were conducted to elicit participants’ perceptions of how their neighborhood influenced their experiences with food security and aging. Participants/settingThirty-eight food-insecure women aged 50 years and older were purposively sampled from the Northern California, Georgia, and North Carolina sites of the Women’s Interagency Human Immunodeficiency Virus Study. Interviews were conducted between November 2017 and July 2018 at the three Women’s Interagency Human Immunodeficiency Virus Study sites. Statistical analysisThree researchers thematically analyzed the data using an inductive–deductive approach. ResultsParticipants described neighborhood-level drivers of food insecurity that centered around three themes: accessibility of food from traditional food stores, the role of food aid institutions, and the intersection of aging with the food environment. Participants explained that food insecurity was related to limited access to food stores largely due to long distances and poor public transportation in Georgia and North Carolina, and high food prices in Northern California. Most participants described being dependent on food aid programs, but found this difficult due to poor quality food and long wait times. Aging-related issues emerged as a cross-cutting theme, with fatigue, poor strength, and chronic illness amplifying barriers to accessing food. ConclusionsFindings from this study reveal the structural barriers that aging women face in accessing healthy food within their neighborhoods, and how experiences with aging and chronic illnesses exacerbate these barriers. Although future programs should address common neighborhood-level barriers such as the accessibility and affordability of healthy foods, they should also be tailored to aging women and the local context.

Household food insecurity associations with pregnancy hypertension, diabetes mellitus and infant birth anthropometric measures: a cross-sectional study of Iranian mothers

ABSTRACT Objective: The purpose of this study was to determine the associations between food insecurity on pregnancy and its outcomes. Materials and methods: This cross-sectional study was carried out on 700 Iranian mothers. Household socioeconomic status, prenatal information and household food security status were assessed using questionnaires. Data analysis was applied by SPSS version 22. Results: The results of the study showed a significant association between food insecurity with gestational diabetes mellitus. The results also showed a significant association between birth weight, and height with pregnancy-induced hypertension. Conclusion: food insecure women should be recognized, and receive appropriate training and assistance.

Gender Disparities in Food Security, Dietary Intake, and Nutritional Health in the United States.

Food insecurity is associated with negative nutritional outcomes and is experienced differently by women vs men. We evaluated the effects of gender on food insecurity and dietary intake in the United States. Data from the National Health and Nutrition Examination Survey (2007-2016) were analyzed. Survey-weighted linear and logistic regression models were used to evaluate predictors of food security and the effect of food security on dietary consumption and body anthropometrics. Gender was modeled as a covariable and as an effect modifier. A total of 30,251 respondents were included. Approximately 15.1% (95% confidence interval [CI]: 14.1%-16.1%) of participants were food insecure. This increased over time from 11.7% in 2007-2008 to 18.2% in 2015-2016. A higher proportion of women experienced food insecurity compared with men (53.3% vs 46.7%, P = 0.02), although this was not significant after adjusting for poverty and other confounders (adjusted odds ratio 1.01; 95% CI: 0.93-1.09; P = 0.81). Among food insecure women, 32.4% (95% CI: 30.0%-34.9%) received emergency food assistance and 75.0% (95% CI: 71.5%-78.2%) received supplemental nutrition assistance benefits. Relative to men, food insecure women were less likely to meet the recommended dietary allowance of most macronutrients and micronutrients. They were also significantly more likely to be obese, have a wider waist circumference, and have higher total body fat percentage (P interaction all <0.001). Food insecurity represents a substantial public health challenge in the United States that differentially affects women compared with men. Alternative strategies may be required to meet the nutritional requirements for food insecure women.

Female sex and food insecurity in relation to self-reported poor or fair mental health in Canadian adults: a cross-sectional study using national survey data.

Background:Women with food insecurity are at higher risk for mental health disorders. This study examined the joint effect of female sex and food insecurity on self-reported poor or fair mental health in Canadian adults.Methods:The analysis was based on data from adults (age ≥ 18 yr) who participated in the Canadian Community Health Survey (CCHS) 2015–2016. We determined past-year food security level (secure, moderately insecure or severely insecure) based on 18 questions. We used log-binomial regression to explore associations of sex and food insecurity with self-reported poor or fair mental health. We measured additive interaction between female sex and food insecurity using relative excess risk due to interaction (RERI).Results:The overall response rate for the CCHS was 59.5%. Data for 61 446 respondents were analyzed. Poor or fair mental health was reported by 4107 participants (6.1% when weighted to the Canadian population). Increased risk of poor or fair mental health was associated with female sex (prevalence ratio [PR] 1.22, 95% confidence interval [CI] 1.12 to 1.31), and moderate (PR 2.50, 95% CI 2.21 to 2.82) and severe (PR 4.03, 95% CI 3.59 to 4.52) food insecurity. Significant additive interaction between female sex and severe food insecurity was found for those aged 40–64 years (RERI 1.38, 95% CI 0.29 to 2.47), and the PR for poor or fair mental health for severely food-insecure women was 5.55 (95% CI 4.48 to 6.89) compared to food-secure men of the same age group.Interpretation:Poor or fair mental health is common in the food-insecure population, and there exists synergism between female sex and severe food insecurity among middle-aged people. This suggests the need to develop targeted mental health support strategies for food-insecure people, specifically middle-aged women.

Exploring the role of social capital in managing food insecurity among older women in the United States.

Food insecurity, which affects 37 million individuals in the United States (U.S.) and disproportionately burdens women, minorities and older adults, is a well-established determinant of poor health. Previous studies suggest social capital, defined as the material and social benefits arising from relationships among individuals within and between groups, may be protective against food insecurity. Drawing on this evidence, calls have been made for interventions and policies to promote social capital to address food insecurity. However, limited research has explored in-depth how social capital shapes the lived experience of food insecurity in the U.S. We explored how older women from three settings in the U.S. used forms of social capital to navigate their food environments. Between November 2017-July 2018, we conducted 38 semi-structured interviews with food-insecure women aged 50 years or older enrolled in the Northern California, Georgia, and North Carolina sites of the Women's Interagency HIV study, an ongoing cohort study of women living with and at risk of HIV. Interviews were analyzed using an inductive-deductive approach. Women from the three sites explained how they drew upon different forms of capital to access food. Women in Georgia and North Carolina depended on support from members within their social group (bonding social capital) to address food insecurity but described limited opportunities to build relationships with members from other social groups (bridging social capital) or representatives of institutions (linking social capital). In contrast, women from Northern California frequently used bridging and linking social capital to access food but described limited bonding social capital. Findings show how the role of social capital in protecting against food insecurity is diverse, complex, and structurally determined. Intervention implications are discussed.

Persistent Food Insecurity, but not HIV, is Associated with Depressive Symptoms Among Perinatal Women in Kenya: A Longitudinal Perspective.

Food insecurity (FI) is an understudied risk factor for depression among perinatal women in sub-Saharan Africa. We therefore explored the longitudinal relationship between FI and depressive symptoms among a cohort of perinatal women of mixed HIV status (n = 371) in Kenya (NCT02974972, NCT02979418). Using longitudinal linear and logistic regressions with random effects, we assessed bivariate and adjusted associations between maternalFI and depressive symptoms. HIV status was also assessed as a potential effect modifier. At baseline, 58% of pregnant women had probable depression (CES-D score > 16) and 84% were severely food insecure. In adjusted analyses, severely food-insecure women had 5.90 greater odds (95% CI 2.32, 15.02, p < 0.001) of having probable depression and scored 4.58 points higher on the CES-D scale(SE: 1.04, p < 0.001) relative to food-secure women. HIV status did not modify the association between FI and depressive symptoms. Interventions to reduce FI may reduce perinatal depression, benefiting mothers and their infants.

Associations among food security, BMI, diet diversity and food consumption patterns of women in rural Kenya

Enhancing food security is one of the United Nations Sustainable Development Goals. Improved agricultural production is an approach to addressing food insecurity. However, these efforts can result in significant changes that are associated with increased risk of non-communicable chronic diseases. Previous research with women in Central Kenya found that the number of years a woman-farmer was engaged in dairy development was associated with greater food security and energy (kJ) intake. No studies have examined food security and the nutrition transition among rural farm women involved in dairy development initiatives. A cross-sectional survey was conducted in 2009 and again in 2017. Chain referral sampling was used in 2009 to recruit 111 women in five groups based on how long they had been a dairy group member (non-members and members from one to more than 10 years). In 2017, 20 women were randomly selected from 85 of the dairy-group member households surveyed in 2009 and a comparison group of 20 women was randomly selected from a list that was generated by referral from the participants. In person one-on-one interviews were conducted with a translator. Demographic, household food security, and dietary intake were collected in both years. In 2009 women’s height and weight data were collected for BMI calculation. Associations among food security, BMI, dietary intake, and year of data collection were examined. Demographic characteristics were comparable between 2009 and 2017 and between food secure and food insecure households. In both years, the majority of households were categorized as not food insecure (67% and 75%; 2009 and 2017, respectively). In 2009 almost half the women (49.4%) had BMIs in the overweight and obese category. Food secure women had a significantly higher median BMI (26.5) compared with food insecure women (24.0). Diet diversity was low (<5) for all women and there was little evidence for a classic “western diet” of the nutrition transition. There was evidence of globalization in food availability and greater purchasing capacity that was demonstrated by the high proportion of women that consumed sugar, refined fats and oils, refined maize and wheat flours, and bread. Household food security was associated with the consumption of sugar, cabbage, wheat flour and bread. These findings support a unique rural nutrition transition, with food security, characterized by low dietary diversity, access to refined basic foods and high unhealthy BMI. Governments and non-governmental organizations need to support nutrition- sensitive agriculture and public health programs to curb the crisis of overweight, undernourishment and chronic diseases. Key words: agriculture, nutrition transition, rural, farm, Kenya, women, BMI, diet diversity

Older men from global settings more vulnerable to clinical changes associated with food insecurity

Abstract Background Studies of the food security status of older adults are rare outside of the United States, especially in low- and middle-income settings. Food insecurity may contribute to disease and disability. Using a diverse sample of older adults, we examine the association of food insecurity with clinical and self-reported measures that are related to disease and impairment. Methods Cross sectional analysis of 1482 older adults from Kingston and St. Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). Outcome measures were Body Mass Index (BMI), waist circumference, and self-reported unintentional weight loss. Food insecurity was assessed with the 9-item Latin American and Caribbean Household Food Security Scale. Covariates were age, sex, study site, and education. Statistical analyses included Student's T-test, Chi-square test, and linear regression. Results 83% of participants were food secure; 12% experienced mild food insecurity and 5%, moderate/severe food insecurity. Among men, BMI and waist circumference varied significantly by food security status (p &amp;lt; 0.05). Mean BMI among men with moderate/severe food insecurity was 25.5 compared to 27.0 for mild and 27.5 for no food insecurity. The pattern for waist circumference was similar (93.9cm for moderate/severe, 96.7cm for mild, and 98.9cm for no food insecurity). More food insecure men reported unintentional weight loss (13%) than food secure men (10%). This pattern was not observed among women. Statistical adjustment for study site, education, and age did not change the findings. Conclusions Significant differences in clinical indicators of disease were observed by food security status in men. At the extreme, low BMI and waist circumference are linked to increased risk of malnutrition, compromised immune function, and respiratory and digestive diseases. Differences in these measures by food security status emphasize the need for gender and age specific food security interventions. Key messages Food insecure men experience clinical indicators of disease significantly more than food insecure women. Successful food security interventions may require sex specific focus across global settings. Little research has been done on food insecurity in elderly outside of North America and study findings contribute to significant gap in sex specific research in this population across global settings.

The Prevalence and Associated Characteristics of Food Insecurity Among U.S. Army Soldiers

Abstract Objectives Food insecurity affects 11% of the United States (U.S.) population and leads to decrements in health and quality of life. Aside from grey literature, little is known about food insecurity among military personnel. The purpose of this study was to identify prevalence, gender discrepancies, and characteristics associated with food insecurity among U.S. Army soldiers. Investigators hypothesized that female soldiers who experience food insecurity will have higher body mass indices (BMI) than male soldiers, and that earning less income, being un-partnered, and having dependents while unmarried would be associated with food insecurity, irrespective of gender. Methods In this cross-sectional study, data were collected from 218 soldiers using the U.S. Household Food Security Survey Module: Six Item Short Form and a demographics questionnaire. Independent samples T-test and Chi square determined differences between samples. Two-way analysis of variance assessed interaction and main effects of food insecurity and gender on BMI. Logistic regressions determined likelihood of food insecurity based on paygrade, gender, marital status, number of dependents, and barracks residence. Results Over 22% of the sampled population was food insecure. When compared to food secure individuals, food insecure soldiers were younger (23.6 vs. 26.6 years) and had fewer dependents (0.70 vs. 1.16). Food insecure women had higher BMIs (25.3 vs. 23.5 kg/m2). Barracks residency was associated with food insecurity (χ2 = 7.290, P = 0.007). Main effects were significant for gender on BMI (P = 0.001), but interaction effects for food insecurity on BMI were not (P = 0.16). Soldiers with the rank of Private (OR = 5.510, P = 0.029) and Specialist (OR = 5.750, P = 0.032) had increased likelihood of food insecurity compared to officers. Conclusions Female soldiers and barracks residents may be most affected by food insecurity, which may have health implications that could affect career advancement and retention. The potential impact of food insecurity on military readiness and resiliency indicates the phenomenon may pose a risk to national security. Funding Sources No funding was received to complete this study.

Promoting Co-Responsibility in the Household and Self-Care Through an Intervention for Food-Insecure Women with Excess Body Weight in Costa Rica

Abstract Objectives This intervention targeted change in gender norms and behaviors regarding co-responsibility in the household and self-care among food-insecure women with excess weight. The objectives of this study were to determine what and how changes occurred in perceived gender norms, attitudes, intentions, and behaviors of women and their family and community members regarding co-responsibility and self-care. Methods We conducted a two-arm, 6-month cluster-randomized controlled trial in Alajuela. This qualitative study included 62 women, 34 family members, and 9 community members in the intensive arm. This arm consisted of activities at the individual (12 two-hour sessions, 3 follow-up monthly sessions, and one closing session), household (one workshop with household and community members, and homework with family participation), and community (two brochures and one workshop) levels. Data used were from observations and content analysis of participant comments during the workshops (n = 83), pre- and post-semi-structured interviews (n = 35), and focus groups with participating women (n = 49). Results Women and family members changed attitudes, intentions, gender norms, and behaviors related to co-responsibility and self-care. Concerning co-responsibility, at baseline all women reported doing most of the domestic work. Most women perceived working outside home as favorable, but those with children worried about childcare. At end-line, women reached more equitable distributions of the domestic work. Many women either obtained a job or began a small business at home and found solutions to balance their job with childcare. Women explained that these changes occurred because they had increased psychological empowerment which allowed them to ask for help at home, search for a job, or accept jobs rejected before. Concerning self-care, women and family members changed self-care behaviors and improved relationships because 1) women understood that self-care first allowed them to care for others and 2) women changed first so their family members followed. Conclusions The intervention changed attitudes, intentions, gender norms, and behaviors related to co-responsibility and self-care, which supported improved food security and weight in women. Funding Sources Office of International Affairs, University of Costa Rica.

Food Security and Diet Quality in Postpartum Women

Abstract Objectives Food insecurity has been associated with poor diet-related health in women, but few prior studies focused on the postpartum period—a particularly important time for the health of women and children. We examined associations between food security and maternal diet quality in a racially diverse cohort of postpartum women. We further assessed whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or the Supplemental Nutrition Assistance Program (SNAP) modified this potential relation. Methods We examined 363 women in central North Carolina from the Nurture study (2013–2017). We computed maternal food security status using the 10-item USDA food security survey module at 3 months postpartum. We calculated Alternate Healthy Eating Index-2010 (AHEI) scores (range of 0 to 100) and component scores from food frequency questionnaires completed at 6 months postpartum. We conducted multiple linear regression examining associations between food security status (high, marginal, low, and very low) and AHEI, adjusting for age, race, education, marital status, number of children, breastfeeding, and total calories. We assessed WIC and SNAP as potential effect modifiers. Results Among women, 64.4% were Black and had a mean (standard deviation, SD) age of 28.2 (5.9) years. Nearly half (45.7%) had a high school diploma or less. Of women, 21.3% had low or very low food security. Mean (SD) AHEI score was 41.5 (11.3). We found no evidence of an interaction between food security and WIC or SNAP so we adjusted for both. In adjusted models, food security status at 3 months postpartum was not associated with AHEI (data not shown) at 6 months postpartum. However, low (ß: −0.64; 95% CI: −1.15, −0.13; P = 0.01) and very low (ß: −0.57; 95% CI: −1.02, −0.13; P = 0.01) food security were associated with a less healthy score for trans fat intake. Conclusions Food security status was not associated with overall diet quality in postpartum women. However, food insecure women showed higher consumption of trans fats. Future research should evaluate interventions to alleviate food insecurity in postpartum women, and assess whether these interventions lead to improved diet quality. Funding Sources National Institutes of Health.

The role of prenatal food insecurity on breastfeeding behaviors: findings from the United States pregnancy risk assessment monitoring system

BackgroundIn addition to its health and nutritional benefits, breastfeeding can save low-income, food insecure mothers the cost of infant formula so that money can be spent on food and other necessities. Yet breastfeeding may exacerbate food insecurity by negatively affecting maternal employment. The relationship between food insecurity and breastfeeding has been explored previously, with varying results. The purpose of this study was to determine the relationship between prenatal food insecurity and breastfeeding initiation and early cessation (< 10 weeks) among U.S. mothers.MethodsData were pooled from 2012 to 2013 (Phase 7) of the Pregnancy Risk Assessment Monitoring System, a population-based cross-sectional survey of postpartum women administered 2–4 months after delivery. The analytic sample was drawn from Colorado, Maine, New Mexico, Oregon, Pennsylvania, and Vermont, and limited to mothers aged 20 years and older whose infants were alive and living with them at the time of the survey (n = 10,159). We used binomial and multinomial logistic models to assess the predictive association between food insecurity and breastfeeding initiation and early cessation, respectively, while controlling for confounders.ResultsMost women reported prenatal food security (90.5%) and breastfeeding initiation (91.0%). Of those who initiated breastfeeding, 72.7% breastfed for > 10 weeks. A larger proportion of food secure women compared to food insecure women, initiated breastfeeding (91.4% vs. 87.6%, P < 0.01), and patterns of early breastfeeding cessation differed significantly between the two groups (P < 0.01). In the final models, prenatal food insecurity was not associated with breastfeeding initiation or early cessation, with one exception. Compared to food secure mothers, mothers reporting food insecurity had a lower risk of breastfeeding for 4–6 weeks than for > 10 weeks, independent of covariates (relative risk ratio 0.65; 95% CI 0.50, 0.85; P < 0.01). Women who were married, had a college degree, and did not smoke were more likely to initiate breastfeeding and breastfeed for a longer time, regardless of food security status (P < 0.01).ConclusionsSocioeconomic, psychosocial, and physiological factors explain the association between prenatal food insecurity and breastfeeding outcomes among this U.S. sample. More targeted and effective interventions and policies are needed to encourage the initiation and duration of breastfeeding, regardless of food security status.

Reducing Both Food Insecurity and Excess Body Weight in Costa Rican Women: A Cluster Randomized Trial

The coexistence of food insecurity and excess body weight has been well documented in women. Both food insecurity and excess body weight have multiple consequences for physical and mental health. Concerns have been raised about interventions aimed to reduce food insecurity because these interventions might contribute to excess body weight, particularly in adult women. The purpose of this study was to develop, implement, and evaluate an intervention to simultaneously reduce food insecurity and body weight through alleviating discouragement-which women described as feeling sad, depressed, hopeless, and lacking drive to do important activities, such as finding a job or studying more-by increasing women's empowerment. This 2-armed cluster RCT was conducted from February to December 2017. Data were analyzed from January to July 2018. Participants were food-insecure women with excess body weight in the Central Canton of the province of Alajuela, Costa Rica. The intensive intervention arm consisted of activities at the individual (12 sessions lasting 2 hours each, 3 follow-up monthly sessions, and 1 closing session), household (1 workshop with the participants' household and community members and homework with family participation), and community (2 brochures and 1 workshop) levels. The nonintensive control arm consisted of 3 sessions about healthy lifestyles lasting 1 hour each. Outcome measures included BMI, waist circumference, and food insecurity. A total of 171 participants were enrolled (83 in intensive and 88 in nonintensive control arms). At 6 months, the intensive arm had greater decreases from baseline in BMI (-0.648, p=0.019), waist circumference (-2.21, p=0.002), and food insecurity (-1.35, p=0.009) compared with the nonintensive control arm. The intensive intervention was effective in simultaneously reducing food insecurity and excess body weight. Educational components should be added to interventions aimed to reduce food insecurity. This study is registered at www.clinicaltrials.gov NCT03492619.

Disparities in antenatal care service utilization among food secure and food insecure women in Gombora District, Hadiya zone, south Ethiopia.

Introductionlittle is known about antenatal care (ANC) utilization difference among food secure and food insecure household pregnant women and factors contributing to inequities in antenatal care use in developing country including Ethiopia. To determine the disparities in the utilization of antenatal care that exists between pregnant women in food secure and food insecure household women.Methodsa community based comparative cross-sectional study was conducted in Gombora District, Hadiya zone, southern Ethiopia. Data were collected from February 25th to March 25th, 2015, using a pre-tested structured questionnaire. Pregnant women were selected by a simple random sampling method. The data were entered using EpiData 3.1 and exported to SPSS version 21 for analysis. Multivariate logistic regression analysis was done to compare antenatal care utilization among food secure and insecure household women at 95% confidence interval (CI). Statistical tests were done at a level of significance of p<0.05.Resultstwo hundred sixty-seven (34.5%) of the respondents received at least one antenatal care visit on current pregnancy. Forty-nine-point one percent of food secure and 23.3% of food insecure household women utilized ANC from health professionals. Factors associated with antenatal care utilization included being from a food secure household (adjusted odds ratio [aOR]= 2.54; 95%CI: 1.79-3.59), having attained secondary or higher education (aOR=3.76; 95%CI: 2.32-6.1), good level of knowledge of antenatal care (aOR= 2.42; 95%CI 1.34-4.33) and being from a wealthy household (aOR=2.10; 95% CI: 1.34-3.28). Conclusion: this study showed a significant variation in the use of ANC in food secure and food insecure household pregnant women. Interventions to improve ANC utilization should prioritize women from poor socio-economic and low educational background.

Combined effects of disease management and food insecurity on physical and mental health in Korean adults.

The present study aimed to examine the combined effects of disease management and food insecurity on physical and mental health in a representative Korean population. A cross-sectional study. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2012-2015. Adults aged ≥30 years (n 17 934) who participated in the KNHANES. Among health-care factors, unmet health-care needs and mental health counselling were different by food insecurity status, with a higher prevalence in adults with food insecurity. The prevalence of underweight was higher in men with food insecurity (5·9 %), whereas the prevalence of obesity was higher in women with food insecurity (37·4 %), than that in men and women with food security. Food insecurity was associated with a high risk of all mental health outcomes. For the combined effects of disease management and food insecurity, unmet health-care needs was related to increased risk of obesity for food-insecure men (Pinteraction = 0·029) and lack of participation in nutrition education or counselling was related to increased risk of obesity for food-insecure women (Pinteraction = 0·010). In addition, higher unmet health-care needs in adults with food insecurity was related to higher risk of mental health outcomes. Unmet health-care needs may exacerbate obesity for food-insecure men and mental health problems for both food-insecure men and women. In addition, lack of participation in nutrition education or counselling may exacerbate the obesity for food-insecure women.

Precarity and health: Theorizing the intersection of multiple material-need insecurities, stigma, and illness among women in the United States

Material-need insecurities (including insecurities in basic resources such as income, food, housing, and healthcare) are widespread in the United States (US) and may be important predictors of poor health outcomes. How material-need insecurities besides food insecurity are experienced, however, remains under-researched, including how multiple material-need insecurities might intersect and converge on the individual. Here we used qualitative methods to investigate experiences with multiple material-need insecurities among 38 food-insecure women aged over 50 years living with or at risk for HIV in the US. Our aims were: (1) to understand the co-experience of material-need insecurities beyond food insecurity; (2) to elucidate how multiple material-need insecurities might intersect; and (3) to discover how this intersection might be detrimental to health. During November 2017–July 2018, we conducted semi-structured interviews at three sites across the US (Northern California, Georgia, North Carolina) and analyzed the data using an inductive-deductive approach. We identified a common and complex picture of multiple material-need insecurities, stigma, and illness among participants across all three sites. There were five primary themes: (1) insecure income arising from a combination of precarious wage labor and federal disability benefits; (2) resultant experiences of uncertainty, compromised quality, insufficiency, and having to use socially unacceptable coping strategies across finances, food, housing, and healthcare; (3) participants’ disempowerment arising from their engagement with social safety net institutions; (4) closely related experiences of intersectional stigma and discrimination; and (5) negative implications for health across a wide range of illnesses. By employing the sociological concept of precarity—a term denoting the contemporary convergence of insecure wage labor and retraction of the welfare state—we combine these themes into a unifying framework of precarity and health. This framework may prove useful for testing how the widespread intersection of multiple material-need insecurities interacts with stigma and discrimination to negatively impact physical and mental health.

Food-Insecure Women Eat a Less Diverse Diet in a More Temporally Variable Way: Evidence from the US National Health and Nutrition Examination Survey, 2013-4.

Food insecurity is associated with high body weight amongst women, but not men, in high-income countries. Previous research using food recalls suggests that the total energy intake of food-insecure women is not elevated, though macronutrient composition may differ from that of food-secure women. There is limited evidence on temporal patterns of food consumption. Here, we used food recalls from women in the 2013-4 cycle of the National Health and Nutrition Examination Survey (NHANES, n = 2798) to characterise temporal patterns of food consumption in relation to food insecurity. Compared to the food-secure, food-insecure women had more variable time gaps between eating; ate a smaller and less variable number of distinct foods at a time; were more variable from day to day in their time of first consumption; were more variable from day to day in the number of times they ate; and consumed relatively more carbohydrate, less protein, and less fibre. However, their overall energy intake was no higher. Food-insecure women had higher BMIs (2.25 kg/m2), and around 15% of the BMI difference between food-insecure and food-secure women was accounted for by their more variable time gaps between eating, their lower diversity of foods, and their lower fibre consumption. Food insecurity is associated with measureable differences in the temporal pattern of food consumption, and some of these differences shed light on how food-insecure women come to have higher body weights.