Food Insecurity Research Articles

Oral Health Care Out-of-Pocket Costs and Financial Hardship: A Scoping Review.

The objective of this study is to characterize how financial hardship related to oral health care (OHC) out-of-pocket (OOP) spending has been conceptualized, defined, and measured in the literature and to identify evidence gaps in this area. This scoping review follows Arksey and O'Malley's framework and synthesizes financial hardship from OHC concepts, methodologies, and evidence gaps. We searched Ovid-Medline, Ovid-Embase, PubMed, Web of Science, Scopus, EconLit, Business Source Premier, and the Cochrane Library. Gray literature was sourced from institutional websites (World Health Organization, United Nations, World Bank Group, Organisation for Economic Co-operation and Development, and governmental health agencies) as well as ProQuest Dissertations and Thesis Global. We used defined inclusion and exclusion criteria to select studies published between 2000 and 2023. Of the 1,876 records, 65 met our criteria. The studies conceptualized financial hardship as catastrophic spending, impoverishment, negative coping strategies, bankruptcy, financial burden, food insecurity, and personal financial hardship experience. We found heterogeneity in defining OHC OOP payments and services. Also, financial hardship was frequently measured as catastrophic health expenditure using cross-sectional designs and national household spending surveys from high-income and to a lesser extent lower-middle-income countries. We identify and discuss challenges in terms of conceptualizing financial hardship, study designs, and measurement instruments in the OHC context. Some of the common evidence gaps identified include studying the causal relationship in financial hardship from OHC, assessing the financial hardship and unmet dental needs due to cost relationship, and distinguishing the effect between pain/discomfort and esthetic/cosmetic dental treatments on financial hardship. Financial hardship in OHC needs further exploration and the use of consistent definitions as well must distinguish between treatments alleviating pain/discomfort from esthetic/cosmetic treatments. Our study is relevant for policy makers and researchers aiming to monitor financial protection of OOP payments on OHC in the wake of universal health coverage for oral health.

Equitable food and nutrition security initiatives for farmers and fisher folks in Masbate, Philippines

Loss of income among Filipino farmers and fisher folks caused by the pandemic resulted to food and nutrition insecurity in their respective households. Their low level of education limited their source of livelihood into small scale farming, fishing, or both thus also limiting their income and opportunity to find additional sources of income. Descriptive statistics was used alongside Smith’s Interpretative Phenomenological Analysis to analyze the data and understand the respondents’ lived experiences. The pandemics negative effect to their source of livelihood prompted them to institute drastic coping mechanisms for survival. Despite the dire situation the respondents still possess a positive outlook in life and have shown their usual resiliency to disasters. Life lessons drawn from them aided in the formulation of personal and organizational development policies in the context of the province of Masbate, Philippines. Finally, the Smart Sirungan Framework for a Food and Nutrition Secure Future was created and presented for possible utilization and further studies.

Marginalised agrarian traditions as a tool for climate justice

Many marginalised communities have long-standing food-growing traditions, yet the climate crisis imperils global food security and disproportionately impacts marginalised communities. Increasingly, researchers posit that networks of decentralised peri-urban agriculture can strengthen food security. In this qualitative study, I ask: what can we learn from marginalised agrarian traditions that might be useful to those marginalised communities in collectively surviving climate change? To answer that question, I conducted in-depth, semi-structured interviews with 23 marginalised food growers and community leaders in the deindustrialised city of Ypsilanti, Michigan, USA. I find that growing food helps to build resilience to food insecurity and climate change but is difficult because of land injustice. Policy and practice implications include the need for the following: (1) housing justice; (2) proactive planning in areas that are expected to serve as climate refuges; and (3) reparations and land rematriation to address the disparate impacts of climate disaster in marginalised communities.

Data-Driven Innovations and Sustainability of Food Security: Can Asymmetric Information Be Blamed for Food Insecurity in Africa?

Africa still struggles to end hunger, partly because not all Africans have access to nutritious food. Although studies have established the connection between digital technologies and food security, the reality in Africa is that, despite the laudable feat in the use of digital technologies, the accessibility and utilization of food still face challenges. Digital agriculture, or technology, is a data-driven innovation that predicts agricultural outcomes and guides food producers throughout the different phases of operations on the farm. The literature documents the efficacy of digital agriculture in food production and availability well, but it has hardly examined how it enhances food accessibility and utilization. And even though studies that have examined food accessibility and utilization have merely assessed income as a tool that guarantees food accessibility and utilization, not much attention has been paid to how digital resources can aid in the access to and utilization of food. Drawing on information asymmetry theory and the systematic qualitative method, this article investigates how digital agriculture, through the internet and mobile phones, enhances efforts towards the accessibility and utilization of food as prerequisites for the attainment of SDG 2 in Africa. The findings provide an understanding of the potential of digital technologies in promoting the accessibility and utilization of food. It advocates strategies through which stakeholders in the agricultural sector can utilize technology in ways that aid Africa’s strategic efforts to attain food security and zero hunger.

Uncovering the drivers of food insecurity in Cameroon: insights from a nationwide cross-sectional analysis

BackgroundDespite global efforts to achieve zero hunger, food insecurity remains a critical challenge in several African countries, including Cameroon. This study aims to identify sociodemographic predictors of food insecurity across Cameroon through a comprehensive, nationwide cross-sectional analysis.MethodsData for this study were drawn from the 2018 Cameroon Demographic and Health Survey (CDHS). Food insecurity levels were evaluated using the Food Insecurity Experience Scale (FIES). To estimate the probabilities of moderate and severe food insecurity among different sociodemographic groups, logistic regression models were applied, with results expressed as average marginal effects (AME).ResultsThe findings reveal that approximately 24.86% of participants experienced moderate food insecurity, while 28.96% faced severe food insecurity. Among men, the proportion experiencing severe food insecurity was 38.8%, compared to 24.3% for women. Multivariable regression analysis showed that severe food insecurity was less likely among women [AME = 0.84, 95% CI = 0.83,0.86], Muslims [AME = 0.91, 95%CI = 0.90,0.93], individuals with higher education levels (secondary education: AME = 0.93, 95%CI = 0.90,0.95; higher education: AME = 0.87, 95%CI = 0.85,0.90), those owning land (either alone or jointly) [AME = 0.92, 95%CI = 0.89,0.96], wealthiest households (moderate food insecurity: AME = 0.91, 95%CI = 0.88,0.93; severe food insecurity: AME = 0.73, 95%CI = 0.70,0.75), female-headed households [AME = 0.97, 95%CI = 0.96,0.99], and rural residents [AME = 0.97, 95%CI = 0.95,0.98].ConclusionsThese findings underscore that food insecurity affects a substantial portion of the Cameroonian population, with certain sociodemographic groups more vulnerable than others. This study proposes targeted policy recommendations to address food insecurity in Cameroon, including social assistance programs for at-risk groups, investments in socioeconomic empowerment, improvements in agricultural productivity, and ongoing research to guide evidence-based interventions.

Reassessing the burden of food insecurity in youth and young adults with youth-onset diabetes: The importance of marginal food security

IntroductionWhereas marginal food insecurity has been recognized as important in Canadian food security policy, the category of marginal food security (MFS) is often ignored in US food security research. MethodsPrevalence of FI was estimated according to the conventional and an alternate classification of MFS with food insecurity among 938 youth and young adults (YYA) with youth-onset type 1 diabetes (T1D) and 156 with youth-onset of type 2 diabetes (T2D) from the SEARCH Food Security Cohort Study (2018-2021). Multivariable regression was used to estimate the association of MFS and conventionally defined food insecurity (FI) ascertained with diabetes-related outcomes, including acute diabetes complications, health care utilization, and diabetes self-management among YYA with T1D. ResultsMFS affected 10% of participants with T1D diabetes and 20% of participants with T2D. Classifying MFS with FI increased FI prevalence from 18.0% to 27.8% in participants with T1D and 34.6% to 55.1% in participants with T2D. Compared to T1D with high food security, YYA with T1D who were FI had higher odds hypoglycemia (2.1, 95%CI 1.2-3.6) and ketoacidosis (1.6, 95%CI 1.0-2.6), but no association was seen in MFS. The FI group also had higher odds of emergency department use and hospitalization (2.3, 95%CI 1.5-3.4; 2.4, 95%CI 1.5-3.9) and lower odds of technology use and checking glucose (0.6, 95%CI 0.4-0.9; 0.3, 95%CI 0.1-0.6). The MFS group exhibited associations of similar directions. Discussion and ConclusionsHealth care providers should consider care of patients with T1D and MFS the same way they care for patients with FI.

Trends in household food insecurity from the Canadian Community Health Survey, 2017 to 2022.

Income-related food insecurity is an important determinant of health. This study aimed to provide an update on the food security status of Canadian households using the most recent available data from a health-oriented national-level survey. This study also examined trends in food insecurity since 2017, and how these have tracked with changes in price inflation. Data on household food security status in the 10 Canadian provinces came from five annual cycles of the population-representative cross-sectional Canadian Community Health Survey (CCHS): 2017, 2018, 2020 (September to December), 2021, and 2022. The Household Food Security Survey Module was used to categorize household food security status during the previous 12 months as food secure or marginally, moderately, or severely insecure. Before 2019, approximately 1 in 10 households had experienced some level of food insecurity in the previous 12 months (9.6% in 2017 and 11.6% in 2018). Household food insecurity prevalence was slightly lower and stable during the COVID-19 pandemic years (8.5% in fall 2020 and 9.1% in 2021) and increased to 15.6% in 2022. Levels of household food insecurity generally tracked with changes in consumer price inflation. Compared with 2021, there were notable increases in levels of moderate and severe food insecurity in 2022 among one-parent households with children, renters, and those reliant on government financial assistance. The prevalence of household food insecurity in the CCHS was relatively stable from 2017 to 2021, increased in 2022, and generally tracked with changes in price inflation. Monitoring levels of household food insecurity will continue to be important as price inflation eases but the cost of living remains high.

Food Surrogates? County-Level Association Between Vegetable Production and Food Insecurity in the Rural South

ABSTRACT This study examines food insecurity in rural Georgia counties. Out of 159 counties in Georgia, 108 met the criterion of over 50% rurality. Despite their central role in U.S. food production, some counties face significant food security issues. We explored the link between food insecurity and harvested vegetable acreage, using regression analysis with county demographics. Results showed no significant correlation between vegetable acreage and food insecurity. We described these areas as possible “food surrogates” and found that factors like food access and poverty were correlated with food insecurity. Further research is needed to understand the challenges of “food surrogate” communities.

The value of indigenous knowledge for enhancing smallholders’ resilience to climate change and food insecurity: a case study of small-scale irrigation system in Niger

ABSTRACT The global south faces challenges in enhancing smallholder farmers' resilience to climate change and food insecurity. Indigenous knowledge and small-scale irrigation (SSI) systems are being promoted as a viable solution to address these challenges. This paper explores how smallholder farmers use local knowledge to establish informal and farmer-led SSI to enhance smallholders' resilience in agriculture and livelihoods. A qualitative research approach with 79 semi-structured interviews was carried out with farmers' households in Tamaske rural community in Southwest Niger, followed by thematic and statistical analysis. The results revealed that an alternative SSI strategy is mostly based on internal agencies rather than externally supported and it serves as a tool to enhance household food and income security amid climate change. The empirical case allows us to assess the value of indigenous knowledge in agriculture by asking how local people can bring together ideas and resources to enhance SSI and build resilience to climate change. The study suggests that the initiation and multiplication of SSI systems can be achieved by farmers' own agencies if appropriate technology and cooperation mechanisms are selected. The policy focus should promote simple, root-based technology as limited government financial support in the global south may hinder this progress.

Climate Change, Racism, and Food Insecurity: Cyclical Impacts of Stressors Exacerbate Health Disparities.

Disadvantaged populations have higher rates of chronic disease, including heart disease, cancer, and diabetes. Race, ethnicity, lower socioeconomic status, and poverty all contribute to these disproportionate rates. Other factors, including systemic racism, climate change, poor diet, lack of food access, and epigenetic influences, that are distributed and experienced differently across vulnerable populations also play a significant role in the development of chronic diseases. This comprehensive review of contributors to chronic diseases emphasizes a unique focus on these identified emerging factors. An ad hoc literature review using OVID Medline and Web of Science was conducted. Findings from prior studies indicate that multiple stressors, both in isolation and in combination, and their negative impacts on both physical and mental health of minorities are exacerbated by climate change. Various stressors dramatically increase chronic disease risk in minority groups. Recommendations for future research to elucidate the impacts of climatic, racial, and dietary adversity with minority populations are presented. Further study in this area is critical for achieving the UN Sustainable Development Goals and improving public health outcomes.

Relationship Between Firearm-Related Deaths and Food Insecurity in Hampton Roads

Relationship Between Firearm-Related Deaths and Food Insecurity in Hampton Roads

Determinants of stunting among adolescent girls in schools of Digo Tsion Town, Northwest Ethiopia: Unmatched case control study.

Stunting is a height-for-age (Z-score) less than minus two standard deviations below the mean of reference standard. It is the most important sign of long-term chronic undernutrition and public health problem in Ethiopia. However, little information was known regarding determinants of stunting among adolescents since it had mostly been investigated in late infancy, especially among children under the age of five. Therefore, identifying determinants of stunting among adolescent girl is still crucial. To identify determinants of stunting among adolescent girls in schools of Digo Tsion Town, Northwest Ethiopia, 2022. Case-control study was conducted among 417 adolescent girls (104 cases and 313 controls) in schools of Digo Tsion Town with computer generated simple random sampling technique. World Health Organization Anthroplus 2007 software was used for analyzing anthropometrics data. Data was collected by epicollect5 mobile application through interview by using structured questionnaire. The data was entered in epi data 4.6 and exported into Statistical Package for Social Science version 26. Variables with p- value ≤ 0.25 in bivariable analysis were candidate for multivariable analysis. Model fitness was checked by Hosmer and Lemon Show fitness of test. Variables having a P-value < 0.05 in multivariable analysis were declared as statistically significant at 95% Cl. The result was presented by statement, figures, and tables. A total of 409 (100 cases and 309 controls) adolescent girls participated, with a response rate of 96% for cases and 98.72% for controls. Food insecurity (AOR = 2.13, CI [1.15, 3.93]), low dietary diversity score (AOR = 1.99, CI [1.06, 3.73]), drinking coffee/tea immediately while eating meals (AOR = 2.19, CI [1.22, 3.95]), not getting nutritional counsel (AOR = 2.07, CI [1.17, 3.66]), chronic illness (AOR = 3.78, CI [1.16, 12.3]), and not visited by health extension workers at home (AOR = 1.85, CI [1.03, 3.31]) were statistically significant determinants of stunting. Stunting among adolescents is influenced by a low dietary diversity score, a food-insecure household, drinking coffee or tea immediately while eating a meal, not receiving nutritional counseling, having a chronic illness, and not being visited by health extension workers at home. Future researchers would do better to undertake prospective studies. Health extension workers are better able to provide nutritional counsel for adolescent.

Understanding Ethiopia’s maize innovation system: Application of integrated innovation system and sustainability transition perspectives

Agricultural innovation is a top priority on the global sustainable development agenda to solve food insecurity, land degradation, climate-change issues, poverty, and unemployment. This paper aims to identify systemic problems and socio-technical transition factors that hinder the development, dissemination, and utilization of improved maize varieties in Ethiopia. Primary data were gathered through structured and semi-structured interview schedules, and then analyzed thematically. Results show that systemic failures such as the absence of key actors, institutional problems, lack of interaction between actors, and inadequate infrastructure are the major hindrances to the systems functioning. Three functions, including entrepreneurship, knowledge development, and creating legitimacy, were found to be weaker than others in the case of improved maize varieties released by Pioneer Hi-Bred Seeds Ethiopia Plc. However, these functions were stronger in the case of improved maize seed varieties released by public research centres. Knowledge dissemination and resource mobilization were the stronger functions of Pioneer Hi-Bred Seeds Ethiopia Plc., which were found to be weak in the public research centres. The result also shows that policies and governance affected the sustainable development of improved maize varieties released by Pioneer Hi-Bred Seeds Ethiopia Plc. Promoting knowledge development and resource mobilization within networks of policymakers, the public sector, and local and foreign private sectors, and a regulation on breeders’ rights to encourage the involvement of private companies in the sector are recommended to enable the innovation system to function sustainably.

Rural household resilience to food insecurity in Mekiet district, Ethiopia

IntroductionFood insecurity remains a global issue and a top national priority in Ethiopia. However, it continues to pose a serious challenge in rural areas. Therefore, this study investigated household resilience to food insecurity among rural residents in Mekiet district.MethodsA cross-sectional research design was used, focusing on two agroecological zones of Mekiet district—lowland and midland—involving 228 respondents. The study employed both quantitative and qualitative approaches. Multistage sampling techniques were employed to select the sample households, and factor analysis was employed to analyze the data.Results and discussionThe results from the factor analysis using the TANGO approach showed that the latent variables of absorptive and adaptive capacities had factor loadings of 0.98 and 0.79, respectively. On the other hand, transformative capacity showed a negative loading (−0.78), with all variables being statistically significant. The mean household resilience capacity index was 0.51. The variables of absorptive and adaptive capacities were positively associated with household resilience capacity, while transformative capacity exhibited a strong negative association. All factor loadings were significant, exceeding the recommended absolute value of 0.364 for sample sizes of 200 or more. Additionally, these variables were also highly correlated with resilience capacity. The study recommends that resilience programs be implemented at district, community, and household levels to enhance resilience to food insecurity.

A Pilot Study Using Continuous Glucose Monitoring among Patients with a Low 1-Hour Glucose Challenge Test Result versus Controls to Detect Maternal Hypoglycemia.

A low 1-hour glucose challenge test (GCT) result (<10th percentile for population) has been associated with neonatal morbidity, including small-for-gestational-age birth weight, and it is hypothesized that underlying maternal hypoglycemia may contribute to this neonatal morbidity. We sought to assess whether eligible patients would undergo continuous glucose monitoring to allow comparison of maternal hypoglycemia between those with a low GCT result versus controls. This exploratory study enrolled patients who completed a GCT between 24 and 30 weeks' gestation from June to September 2022. English- or Spanish-speaking participants aged ≥18 years wore a blinded continuous glucose monitor (CGM) for 10 days. There were 10 participants each in the low GCT (<82 mg/dL) and normal GCT group. Proportions were calculated to determine recruitment rates and describe the low versus normal glycemic groups across clinical and sociodemographic characteristics. Maternal hypoglycemia, defined using various proposed thresholds, was analyzed as continuous data (time duration) with Student's t-tests and categorical data (number of episodes) with chi-square tests and bivariate analyses were performed comparing participants with a low versus normal GCT. Primary outcome measures were recruitment, enrollment, and adherence rates, and overall glycemic values for each group. Of 64 eligible patients, 58 (91%) were approached, and of them, 20 (35%) were enrolled. All 20 participants had CGM data to review with 100% adherence. Average glucose values were similar between participants in the low GCT and normal GCT groups (111.7 ± 18.0 vs. 111.6 ± 11.7 mg/dL, p = 0.99), and participants with a low GCT value did not demonstrate more hypoglycemia than those with a normal GCT value across five proposed thresholds on CGM analysis. In this pilot study, participants wore blinded CGMs to collect glycemic data, and those with a low GCT result did not experience more hypoglycemia than those with a normal GCT on CGM analysis. · Study participants wore continuous glucose monitors in blinded mode to gather glycemic data with 100% adherence.. · Participants with a low GCT result (<82 mg/dL) as compared with those with a normal GCT result were not more likely to demonstrate maternal hypoglycemia using several thresholds on CGM analysis.. · In our cohort, there were few participants in either glycemic group who reported food insecurity or lived in a food desert..

"It's Really About Those Social Determinants of Health that Drive It": Addressing Food Insecurity in Rural Veterans.

The Department of Veterans Affairs (VA) employs numerous strategies to address food insecurity among rural veterans. This manuscript discusses findings from a quality improvement project examining factors impacting food insecurity among rural veterans. Qualitative interviews were conducted with VA expert informants (n = 30) who worked in national program offices addressing veteran food insecurity, site visit participants (n = 57) at three VA Medical Centers (VAMCs), and rural veterans who screened positive for food insecurity at the VAMC sites (n = 10). Interviews were analyzed with analysis matrices. Current VA programming includes a national food insecurity screening initiative and connecting veterans with local community resources. Veteran participants provided suggestions for addressing veteran food insecurity, including outreach and education. In addition, these interviews demonstrate that rural veteran food insecurity is intrinsically interwoven with other social determinants of health. Addressing rural veteran food insecurity must include strategies for understanding and supporting interconnected veteran needs.

The Analysis of Factors that Influence Stunting

Stunting in children is a national problem caused by many factors that harm human resources in the future, including an impact on decreasing intelligence, vulnerability to disease, hampering economic growth, work productivity, exacerbating inequality, and height growth is shorter than age in general. Stunting in children under five is a consequence of several factors that are often associated with poverty, including nutrition, health, sanitation, and the environment There are five main factors that cause stunting, namely poverty, social and cultural, increased exposure to infectious diseases, food insecurity and community access to health service. The purpose of this literature review was to analyze the factors that influence stunting. The article was obtained from a SINTA accredited journal published in the 2013-2023 period with the same title, as well as the same research design. The selected articles were then tested for plagiarism, and nine articles with the smallest plagiarism level were selected. Analysis PICO (Population, Intervention, Comparison, Outcome) is carried out on each article, followed by making conclusions. The results of the analysis determined that factors that influence stunting include social and cultural, increased exposure to infectious diseases, food insecurity and community access to health services alone or together. The author hopes that this research will further greatly help how to do health promotion, case finding and prevention, and, many sectors must be involved and work together for the problem of stunting.

I Know I Am Ugly, but Please Listen to My Story First: An Examination of How Storytelling Can Impact Consumers' Valuation of Unattractive Produce

ABSTRACTIn a world where food insecurity and food waste paradoxically coexist, the rejection of aesthetically imperfect yet edible produce significantly contributes to food waste. This study examines the application of compelling storytelling to alter consumer perceptions and behaviors toward unattractive produce, a perspective largely overlooked in sustainability research. We address this gap by exploring how storytelling can mitigate cognitive biases against such produce, thereby enhancing consumer acceptance through improved perceived taste. In Study 1, we examine the effect of unattractive produce on produce valuation and the mediation of perceived taste. In Study 2, we investigate the moderating role of storytelling in enhancing consumers' perceived taste of unattractive food. Through two experimental studies, we confirm that combining storytelling with marketing tactics, such as coupons, significantly increases consumers' consumption of unattractive produce. We recommend retailers utilize storytelling in marketing unattractive produce to optimize marketing effectiveness and promote sustainable food consumption. Our findings advance storytelling, visual marketing, and unattractive produce literature and offer practical insights for reducing food waste, contributing to sustainability efforts and social welfare. By employing a storytelling strategy, we support social good by encouraging the consumption of “ugly” produce.

Hunger in global war economies: understanding the decline and return of famines.

The resurgence of famines is a topic of concern. This paper explains the recent trajectory using the framework of contending 'global war economies'. It characterises the unipolar neoliberal world order era (1986-2015) as the 'Pax Americana' war economy, focusing on the United States dollar's roles. These were the decades of the liberal imperium, the corporate food regime, and counterinsurgent coalitions, which generated structural vulnerability to food crises and reduced the actual incidence and lethality of famine. The paper characterises the subsequent period (2016 onwards) as the challenge of the BRICS club, focusing on its efforts to rewrite the global political economy's rules, proactively hedging among diversifying currency regimes. This entails a scramble to secure strategic commodities and infrastructure in subaltern countries, which is intensifying conflict and food insecurity, and revising international norms in favour of reasserting sovereign rights. The global political-economic contestation and, especially, the associated normative regression are permissive of political and military triggers of famine.

Social Determinants of Health Affect Psychological Distress among People with Disabilities

People with disabilities experience inequitable exposure to social determinants of health (SDOH) that contribute to disparate health outcomes, including psychological distress. There is little research examining which SDOH have the strongest effect on psychological distress among people with disabilities. This leaves healthcare providers and policy makers with insufficient information to make well-informed treatment decisions or allocate resources effectively. We explored the association between SDOH and disability and which factors may moderate the association between disability and psychological distress. Using data from the US Census Bureau’s Household Pulse Survey (Phase 3.5), we examined SDOH among people with and without disability (n = 26,354). Among people with disability, the odds of severe psychological distress were highest among those who had low incomes (OR = 4.41, 95% CI: 3.51–5.60), were food insecure (OR = 3.75, 95% CI: 3.43–4.10), housing insecure (OR = 3.17, 95% CI: 2.82–3.58), or were unable to work (OR = 1.98, 95% CI: 1.80–2.18). Only difficulty paying for household expenses moderated the association between disability and severe psychological distress (OR = 9.81, 95% CI: 7.11–13.64). These findings suggest that supporting employment and economic opportunities and improving access to safe and affordable housing and food may improve psychological well-being among people with disabilities.