Higher Risk Of Food Insecurity Research Articles

Abstract PO1-10-03: Prevalence of and Factors Associated with Food Insecurity and Other Adverse Social Determinants of Health Among Breast Oncology Patients

Abstract Background: Social determinants of health (SDOH), the non-medical factors that influence health status, have a profound impact on breast cancer (BC) outcomes and contribute to survival disparities. Food insecurity (FI), defined as a lack of consistent access to adequate food resources, is a modifiable SDOH associated with treatment disruptions, medication nonadherence, and decreased quality of life. To identify at-risk patients and inform future interventions, we implemented SDOH screening of patients seen in breast oncology clinic at our urban academic medical center. Methods: Screening was conducted through an 8-item questionnaire on the electronic patient portal. The questions covered FI, housing and transportation challenges, and emergency department (ED) visits. We conducted a retrospective analysis of SDOH data collected among patients scheduled for a breast oncology appointment between 11/1/22 and 5/25/23. Any level of food hardship or concern constituted a positive FI screen. Descriptive statistics were used to determine the prevalence of FI and other SDOH, to assess differences in FI rates by age, race/ethnicity, and clinical stage, and to compare characteristics of food-insecure vs food-secure patients. We also conducted a multivariable logistic regression analysis to estimate the odds ratio (OR) and 95% confidence interval (CI) associated with sociodemographic/clinical factors and FI. Results: A total of 2,585 patients were seen in our breast oncology practice, of which 1,189 (46.0%) were screened for SDOH, including 41.2% non-Hispanic White (NHW), 9.6% non-Hispanic Black (NHB) and 21.0% Hispanic patients. Among patients who responded to each SDOH question, 15.5% (146/940) reported some level of FI; 8.7% (84/962) were unable to pay their rent or mortgage on time; for 5.8% (57/989), lack of transportation interfered with their treatment. The FI rate differed significantly by race and ethnicity: 4.5% of NHW, 15.2% of NHB, and 41.8% of Hispanic patients reported FI (p< 0.001). In multivariable analysis, NHB and Hispanic patients also had significantly higher odds of FI compared to NHW patients (OR=3.68, 95% CI=1.7-7.7, p< 0.001 for NHB and OR=15.0, 95% CI=8.8-27.1, p< 0.001 for Hispanic patients). Patients with metastatic disease had higher rates of FI compared to other breast oncology patients (23.6% vs 14.8%, p=0.048), and a metastatic BC diagnosis was associated with over twice the odds of FI (OR=2.18, 95% CI=1.1-4.2, p=0.02). Among food-insecure patients, 41.1% were unable to pay their rent or mortgage on time and 22.6% reported transportation difficulties interfering with treatment (vs 2.6% and 2.4%, respectively, for food-secure patients (p< 0.001)). Compared to food-secure patients, those who were food-insecure had significantly higher rates of self-reported ED visits in the past 12 months: 18.8% vs. 33.6% reported at least 1 ED visit, respectively, and 5.2% vs. 16.4% reported multiple ED visits, respectively (p< 0.001). Conclusions: In this analysis of SDOH data among patients seen in breast oncology clinic, FI was the most common social health risk reported, with nearly a quarter of patients with metastatic BC reporting FI. Racial/ethnic minorities were also at considerably higher risk for FI. ED utilization was significantly higher among food-insecure patients. Targeted interventions to reduce FI in at-risk populations are warranted to improve clinical and healthcare utilization outcomes. Sociodemographic and Clinical Characteristics and Other Reported Social Determinants of Health Among Food-Secure vs Food-Insecure Patients Citation Format: Claire Sathe, David DeStephano, Anita Gul, Melissa Beauchemin, Justine Kahn, Melissa Accordino, Katherine Crew, Ngozika Emezienna, Dawn Hershman. Prevalence of and Factors Associated with Food Insecurity and Other Adverse Social Determinants of Health Among Breast Oncology Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-03.

Calgary assessment model: study of family units with child malnutrition

To describe the experience of using the Calgary Family Assessment Model in two family units with child malnutrition, as well as to construct their genogram and ecomap, analyzing the profile of the family structure. This is a case study carried out with two families, with a qualitative approach, developed in a reference unit for early childhood care, located in the city of Fortaleza-CE, from March to May 2023. ethical assessment with CAAE 66662422.8.0000.5049. Family 2 presented a higher risk of food insecurity, since only one of its components (F1) is the breadwinner. In addition, it was found that the therapies used in nutritional monitoring achieved greater adherence in Family 1, correlated with greater access to food, as well as the higher level of education of its members. However, through the application of the Calgary Model of Family Assessment, one can recognize the ability of families to solve problems, as well as inhibitions related to the educational nature that make it difficult to adhere to the interventions offered about child malnutrition.

The Influence of the COVID 19 Pandemic on Food Insecurity Among Cancer Survivors Across New York State.

People surviving cancer represent a particularly vulnerable population who are at a higher risk for food insecurity (FI) due to the adverse short- and long-term effects of cancer treatment. This analysis examines the influence of the COVID-19 pandemic on the prevalence of FI among cancer survivors across New York State (NYS). Data from the 2019 and 2021 NYS Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate the prevalence of FI. Multivariable logistic regression was used to explore socioeconomic determinants of FI. Among cancer survivors, FI varied geographically with a higher prevalence in New York City compared to the rest of the state (ROS) prior to (25.3% vs. 13.8%; p = .0025) and during the pandemic (27.35% vs. 18.52%; p = 0.0206). In the adjusted logistic regression model, pre-pandemic FI was associated with non-White race (OR 2.30 [CI 1.16-4.56]), household income <$15,000 (OR 22.67 [CI 6.39-80.43]) or $15,000 to less than <$25,000 (OR 22.99 [CI 6.85-77.12]), and more co-morbidities (OR 1.39 [CI 1.09-1.77]). During the pandemic, the association of FI with non-White race (OR 1.76 [CI 0.98-3.16]) was attenuated but remained significant for low household income and more co-morbidities. FI was newly associated with being out of work for less than one year (OR 6.36 [CI 1.80-22.54] and having one (OR 4.42 [CI 1.77-11.07]) or two or more children in the household (OR 4.54 [CI 1.78-11.63]). Our findings highlight geographic inequities and key determinants of FI among cancer survivors that are amendable to correction by public health and social policies, for which several were momentarily implemented during the pandemic.

Revealing Campus Food Insecurity at Urban, Private, Liberal Arts Universities

ABSTRACT To address existing and emerging food access needs, three metro private universities in the midwest, with increasingly diverse student bodies representing historically underrepresented backgrounds, utilized a web-based Food Access Survey to collect students’ self-reported experiences (n = 1,478) accessing food and experiencing hunger. The results from this survey highlight those with marginalized identities are at a higher risk for food insecurity. Given increasing enrollment of marginalized students and diversifying student bodies across all institutions, including private universities, we argue higher education needs to recognize, assess, and act on student food insecurity.

Prevalence of food insecurity amid COVID-19 lockdowns and sociodemographic indicators of household vulnerability in Harar and Kersa, Ethiopia

BackgroundThe COVID-19 pandemic was associated with widespread social disruptions, as governments implemented lockdowns to quell disease spread. To advance knowledge of consequences for households in resource-limited countries, we examine food insecurity during the pandemic period.MethodsWe conducted a cross-sectional study and used logistic regression to examine factors associated with food insecurity. Data were collected between August and September of 2021 through a Health and Demographic Surveillance System (HDSS) using a survey instrument focused on knowledge regarding the spread of COVID-19; food availability; COVID-19 related shocks/coping; under-five child healthcare services; and healthcare services for pregnant women. The study is set in two communities in Eastern Ethiopia, one rural (Kersa) and one urban (Harar), and included a random sample of 880 households.ResultsRoughly 16% of households reported not having enough food to eat during the pandemic, an increase of 6% since before the pandemic. After adjusting for other variables, households were more likely to report food insecurity if they were living in an urban area, were a larger household, had a family member lose employment, reported an increase in food prices, or were food insecure before the pandemic. Households were less likely to report food insecurity if they were wealthier or had higher household income.ConclusionsAfter taking individual and household level sociodemographic characteristics into consideration, households in urban areas were at higher risk for food insecurity. These findings suggest a need for expanding food assistance programs to more urban areas to help mitigate the impact of lockdowns on more vulnerable households.

Food insecurity and disability among working-age and older adults.

To explore relationships between disability, food insecurity (FI) and age and examine how socio-economic factors impact risk of FI among disabled people in working and older age. Logistic regression models used to analyse the contribution of socio-economic factors to gaps in risk of FI for disabled people. In models stratified into working and older age groups, differences in risk of FI for disabled and non-disabled people were examined by employment, education and assets. England, Wales and Northern Ireland, 2016 and 2018. A representative sample of 6187 adults aged 16+, of whom 28 % were disabled, from the Food & You survey. The gap in FI risk by disability status decreased as age increased. For ages 25-34 for disabled v. non-disabled people, risk of FI was 31 % (95 % CI 21-41 %) v. 10 % (8-12 %); at ages 45 to 54, it was 18 % (11-23 %) v. 7 % (5-8 %), and at ages 75+, there was no gap in risk. Accounting for socio-economic variables halved the gap in risk among working ages. However, among working-age adults, FI among disabled people in full-time work was 15 % (11-20 %) compared with only 7 % (6-9 %) among non-disabled people in full-time work. Among older people, disabled people without savings were at higher risk of FI (5 % (3-7 %)) than non-disabled people without savings (2 % (1-3 %)) but having savings closed risk gap. Socio-economic resources partially explain disparities in FI risk when disabled. Disparities remained for people in full-time work and among people without savings in older age.

Association between food insecurity status, campus food initiative use and diet quality in Australian university students.

University students may experience food insecurity due to financial constraints, reducing the quality of their diet. This study aimed to identify students at higher risk of food insecurity, their engagement with on-campus food initiatives and evaluate the relationship between food insecurity and a validated index of diet quality. A cross-sectional online survey used the six-item Household Food Security Survey Module to assess food insecurity. Total diet quality and subscale scores for eight food groups were measured using the Australian Recommended Food Score (range 0-73). Univariate and multivariate regression identified groups at risk of food insecurity, their engagement with campus food initiatives and relationship with diet quality scores. Of student respondents (n = 197), over half (54%) experienced food insecurity (14% mild, 23% moderate and 18% severe food insecurity). Male students and students not living with parents were at significantly higher risk. Food-insecure students were significantly more likely to use the campus food pantry (odds ratio = 2.3 [95% confidence interval = 1.286-4.142]; p = 0.005) but not a campus community garden. The mean diet quality score was 32.9 (standard deviation = 8.9). Food-insecure students reported a mean diet quality score over three points lower than food-secure respondents (B = -3.5 [95% confidence interval = -6.0 to -1.0]; p = 0.006), with significantly lower fruit and vegetable subscale scores. Results suggest a high occurrence of food insecurity and poor dietary quality in university students. Despite high levels of engagement with the campus food pantry, the poor diet quality of food-insecure students suggests an urgent need for greater university-led interventions to improve students' dietary intake.

Examining the disparities: A cross-sectional study of socio-economic factors and food insecurity in Togo.

Despite many interventions, Togo continues to have one of the highest rates of poverty and food insecurity in the sub-Saharan African region. Currently there is no systematic analysis of the factors associated with household food-insecurity in this country. This study aimed at exploring the factors associated with food insecurity in Togo. This was a cross-sectional study that used data from five waves (2014 to 2018) of the Gallup World Poll (GWP) for Togo. Sample size included 4754 participants, aged 15 and above. Food insecurity was measured using the Food Insecurity Experience Scale (FIES) questionnaire as per the Food and Agricultural Organization (FAO) guidelines. Our outcome variable was food insecurity, categorized as: 1) food secure (FIES score = 0-3), moderately food insecure (FIES score = 4-6), and severely food insecure (FIES score = 7-8). We did descriptive and multinomial regressions to analyze data using Stata version 16. Between 2014 and 2018, the percentage of severe food insecurity fluctuated-42.81% in 2014, 37.79% in 2015, 38.98% in 2016, 45.41% in 2017, and 33.84% in 2018. Whereas that of moderate food insecurity increased from 23.55% to 27.33% except for 2016 and 2017 where the percentage increased to 32.33% and 27.46% respectively. In the logistic regression analysis, we found that respondents with lower than elementary education had a higher relative risk ratio of moderate (RRR = 1.45,95%CI = 1.22-1.72) and severe (RRR = 1.72, 95%CI = 1.46-2.02) food insecurity compared to those with secondary and higher education. Rural respondents had higher RRR of severe food insecurity (RRR = 1.37, 95%CI = 1.16-1.62) compared to those who lived in the urban areas. Compared with those in the richest wealth quintile, respondents in the poorest wealth quintile had 2.21 times higher RRR of moderate (RRR = 2.21, 95%CI = 1.69-2.87) and 3.58 times higher RRR of severe (RRR = 3.58, 95%CI = 2.81-4.55) food insecurity. About two-thirds of participants experienced some level of food insecurity in 2018. Lower levels of education, rural residency and poorer household wealth index areas were associated with a higher risk of food insecurity. National food security programs should focus on promoting education and improving socioeconomic condition of people especially in rural areas.

Evaluation of a Nutrition Education and Skills Training programme in vulnerable adults who are at high risk of food insecurity.

In Australia, the prevalence of food insecurity increased by 1.5% between 2014 and 2016 and 2018 and 2020 due to effects of the COVID-19 pandemic. OzHarvest offers a 6-week Nutrition Education and Skills Training (NEST) programme to adults at risk of food insecurity. NEST provides 2.5-h weekly cooking workshops on simple, healthy and affordable meals. This study aimed to determine the immediate (post) and longer-term (6 months) impacts of participation in NEST. A quasi-experimental study with pre-post surveys (n = 258) and 6-month follow-up surveys (n = 20) was conducted from June 2019 to July 2022. Survey results were obtained from NEST programme participants (≥18 years) from six major Australian cities. Participants demonstrated immediate improvement in nutrition knowledge (p < 0.001), food preparation behaviours (p < 0.001) and confidence and self-efficacy (n = 222; p < 0.001). Intake of discretionary foods decreased (p < 0.001), whereas fruit, vegetable and water intake increased (p < 0.001). Food security improved from 57% to 68% immediately after the completion of the programme (p < 0.001). Participants demonstrated longer-term improvements in nutrition knowledge (p < 0.001), cooking confidence (n = 8; p = 0.03), food preparation behaviours (p = 0.003) and increased vegetable (p = 0.03) and fruit intake (p = 0.01). Participation in OzHarvest's NEST programme results in short-term improvements in food security levels and dietary behaviours. Over the longer term, these changes were sustained but to a lesser degree, indicating that systemic changes are required to address underlying socio-economic disadvantages.

The association of Supplemental Nutrition Assistance Program (SNAP) benefits and breast, cervix, and colorectal cancer screening.

131 Background: Food insecurity is associated with healthcare access and utilization. The Supplemental Nutrition Assistance Program (SNAP) was created to reduce food insecurity for low-income households and hence may enhance health-seeking behaviors. However, it is unknown whether receipt of SNAP benefits is associated with rates of cancer screening. Our objective was to quantify the relationship of SNAP benefit receipt with cancer screening among low income individuals at high risk for food insecurity. Methods: The National Health Interview Survey (NHIS) provided by the Center for Disease Control and Prevention was utilized to identify high-risk adults ages 21 to 74 years eligible for screening for female cervix (21-65 years), colorectal (40-74 years), and/or female breast cancer (40-74 years). Data was included from the 2019 and 2021 surveys, with 2020 excluded due to limited cancer screening information. High-risk was defined as low or very low food security, household income &lt; 125% federal poverty level, or having Medicaid insurance. Up to date cancer screening was defined as receipt of mammography within 2 years for breast cancer; receipt of a cervical cancer test within 5 years for cervix cancer; and receipt of sigmoidoscopy within the past 5 years, colonoscopy within 10 years, fecal immunohistochemistry (FIT) testing within 1 year, or sDNA-FIT testing within 3 years for colorectal cancer. We utilized logistic regression to compare screening rates by receipt of SNAP benefits and accounted for the complex survey design of the NHIS. Models were adjusted for covariates including age, race, ethnicity, sex (colorectal cancer screening only), income, education, marital status, insurance status, metropolitan residence status, survey year, food insecurity, and comorbidities. Results: A total of 6,111, 4,141, and 7,015 respondents were identified for cervix, breast, and colorectal cancer screening analyses, respectively. Among these respondents, 67%, 61%, and 60% were up to date on cervix, breast, and colorectal cancer screenings, respectively. Among this high-risk cohort, 43% of respondents reported receipt of SNAP benefits. Receipt of SNAP benefits was associated with increased odds of cervical cancer screening (OR = 1.18, 95% CI = 1.00 – 1.39, P=.046), which was limited to females ages 21-39 (OR = 1.36, 95% CI = 1.05 – 1.77, P=.022). Receipt of SNAP benefits was not associated with increased rates of breast or colorectal cancer screening. Conclusions: Receipt of SNAP benefits is associated with higher rates of cervical cancer screening among low-income females at high risk of food insecurity, particularly among young adults. These data suggest that efforts to address social determinants of health may improve access to care.

Risk of financial stressors in patients diagnosed with cancer: Lessons from a nation-wide financial navigation program.

204 Background: Financial toxicity associated with a cancer diagnosis can lead to poor outcomes in both non-medical and medical domains. Family Reach, a US-based nonprofit, is dedicated to removing financial barriers between cancer patients and their treatment through comprehensive financial navigation. In this study, we sought to understand the prevalence of medical and non-medical financial stressors in a cohort of patients receiving financial navigation. Methods: Patient application data (provided by patients, caregivers, or case workers) from the Family Reach program from March 2020 - June 2022 were analyzed. Data included patient demographics; clinical and financial attributes; and medical &amp; non-medical financial stressors. Associations between stressors and patient characteristics were assessed using descriptive statistics, multivariable, and univariate tests using SPSS. Results: 10,558 applications from 50 states and D.C. were processed in the study period: 92% had annual household income &lt;$70,000 (US median -$70,784 in 2021).Data were stratified by type of cancer (55% solid vs. 38% hematologic); age (32% pediatric, 32% Adolescents and Young Adults, &amp; 36% adult, defined by NCI as pediatric - 0-14 years, AYA - 15-39 years, and adult – 40+ ); and race/ethnicity [41% non-Hispanic White (W), 22% non-Hispanic Black (B), 16% Hispanic/Latinx (H/L)]. Other race categories (20%) were not analyzed due to small sample sizes (0.9% AI/AN, 4% Asian American, 8% two or more races) Race/ethnicity: 85% B and 84% H/L patients had an annual household income &lt;$50,000, compared to 65% W patients (X2 p&lt;0.05). B and H/L respondents were more likely to belong to single-parent households (59% B, 40% H/L, 30% W, X2 p&lt;0.05). Both groups were at a higher risk of food insecurity (B vs. W, OR=1.8, H/L vs. W, OR=1.9), utility shut-off (B vs. W, OR=1.9, H/L vs. W, OR=1.4), phone shut-off (B vs. W, OR=2.0, H/L vs. W, OR=1.2) and houselessness (B vs. W, OR=1.8, H/L vs. W, OR=1.7), after adjustment for geography. Age of cancer onset: No income differences were observed between pediatric, AYA, &amp; adult patients. Adult (OR=3.2, p&lt;0.05) &amp; AYA (OR=1.9, p&lt;0.05) patients had a higher risk of unpaid medical expenses, as compared to pediatric patients, after adjustment for income &amp; geography. While no significant differences were seen between solid and heme cancers, lung patients were at a higher risk of financial distress from non-medical expenses (e.g., risk of homelessness OR = 1.4, p&lt;0.05) as compared to breast, colon, and prostate combined, after adjustment for income &amp; geography. Conclusions: To our knowledge, this is the first analysis of financial stressors in a national cohort of cancer patients receiving financial navigation. The higher prevalence of financial stressors in patients of color in this self-selected group indicates that interventions addressing cancer need to integrate social determinants of health.

Food Insecurity, Disability and Age

Abstract Background Food insecurity is a growing public health concern. Disabled people are at higher risk of food insecurity than non-disabled people. Evidence suggests this diminishes for older people. We examine how the relationship between disability and food insecurity varies at different ages and explore the extent to which socio-economic factors account for and modify the relationship. Methods Data came from the fourth and fifth waves of the UK's Food Standards Agency's Food and You survey (n = 6,187), which contain data on disability and household food insecurity. We explored predicted probabilities of food insecurity from logistic regression models between disabled and non-disabled people for 10-year age cohorts. Stratified analyses, further explored differences in vulnerability to food insecurity at working age and 65+. Results Predicted probability of food insecurity for disabled people declined with age, as did the gap in risk between disabled and non-disabled people. The predicted probability of food insecurity among disabled people under 65 was 23% (95% CI: 19%-27%), whereas for disabled people 65+, it was 5% (95% CI: 3%-7%). Among people of working age, socio-economic factors explained some, but not all, of the increased risk of food insecurity associated with disability. Disabled people in full-time work were still significantly more likely to be food insecure than non-disabled people in work: 15% (95% CI: 11%-20%) vs 8 % (95% CI: 6%-9%) respectively. Among older adults, disabled people with savings were not at significantly higher risk of food insecurity, whereas those without savings were: 0.4% (95% CI: 0.4%-1%) vs 5% (95% CI: 3%-7%), respectively. Conclusions Findings indicate the increased risk of food insecurity for disabled people is partially explained by socio-economic factors. However, there is a need for further research to explain unobserved risk factors for food insecurity among disabled people of working age especially. Key messages • Socioeconomic factors play an important role in disabled people's increased risk of food insecurity. • Observed socioeconomic factors alone do not fully explain increased risk of food insecurity among working age disabled people. More research is needed.

Prevalence of adolescent-reported food insecurity and the determinants including coping strategies living in urban slum communities of Bangladesh during the era of COVID-19: a cross-sectional study

BackgroundAs food insecurity (FI) continues to rise worldwide especially in developing countries like Bangladesh, adolescent experience of FI have received minimal attention globally. This study aimed to identify the prevalence of adolescent-reported FI and its association with individual and socio-environmental factors as well as coping strategies amongst a sample of adolescents living in urban slum areas of Bangladesh in the times of the Coronavirus 19 (COVID-19) pandemic.MethodsA descriptive cross sectional study was conducted amongst 326 adolescents (12–18 years) living in the urban slums of Narayanganj, Dhaka from April to May, 2022. Adolescent-reported FI was assessed using a structured questionnaire adopted from Household Food Insecurity Access Scale (HFIAS). Descriptive statistics, Chi-square tests and ordinal logistic regression were used to draw inference.ResultsPrevalence of adolescent-reported FI was high (46.6% moderate and 29.8% severe). The likelihood of experiencing moderate or severe FI versus no/mild FI were 1.7 times (95% Confidence Interval (CI) [1.1, 2.5]) higher in younger adolescents and 5 times (95% CI [2.3, 12.7]) higher in unemployed youth. Socio-environmental factors determining the economic status of a household such as higher number of family members, only one earning family member, unemployed father, no household assets, food aid received by the family during pandemic and positive COVID-19 infection in family were associated with moderate and severe FI. Coping strategies such as a higher number of food seeking strategies (Adjusted Odds Ratio (AOR) 3.4, 95% CI [1.9, 5.9]), substance use (AOR 6.2, 95% CI [1.2, 31.7]) and stopping school (AOR 3.3, 95% CI [1.9, 5.7]) increased odds for moderate and severe FI. Stratified by drop-out of school status, an association between food seeking strategies and FI remained significant among those school-going, while there was no association among those dropping out of school.ConclusionThis study showed that adolescents living in urban slum communities in Bangladesh are at very high risk of FI and resort to harmful coping strategies. Our study highlights the importance of further research in adolescent reported FI and coping strategies in low to middle income countries (LMICs) and create appropriate interventions to lower FI among this group and improve their state of health and wellbeing.

Experiencing food insecurity in childhood: influences on eating habits and body weight in young adulthood.

To examine how food insecurity in childhood up to adolescence relates to eating habits and weight status in young adulthood. A longitudinal study design was used to derive trajectories of household food insecurity from age 4.5 to 13 years. Multivariable linear and logistical regression analyses were performed to model associations between being at high risk of food insecurity from age 4.5 to 13 years and both dietary and weight outcomes at age 22 years. A birth cohort study conducted in the Province of Quebec, Canada. 698 young adults participating in the Québec Longitudinal Study of Child Development. After adjusting for sex, maternal education and immigrant status, household income and type of family, being at high risk (compared to low risk) of food insecurity in childhood up to adolescence was associated with consuming higher quantities of sugar-sweetened beverages (ßadj: 0.64; 95% CI: 0.27-1.00), non-whole-grain cereal products (ßadj: 0.32; 95% CI: 0.07-0.56), and processed meat (ßadj: 0.14; 95% CI: 0.02-0.25), with skipping breakfast (ORadj: 1.97; 95% CI: 1.08-3.53), with eating meals prepared out of home (ORadj: 3.38; 95% CI: 1.52-9.02), with experiencing food insecurity (ORadj: 3.03; 95% CI: 1.91-4.76), and with being obese (ORadj: 2.01; 95% CI: 1.12-3.64), once reaching young adulthood. Growing up in families experiencing food insecurity may negatively influence eating habits and weight status later in life. Our findings reinforce the importance of public-health policies and programs tackling poverty and food insecurity, particularly for families with young children.

Food insecurity in international and domestic students at an Australian university 2 years into the global COVID-19 pandemic

ObjectivesThe aim of this article is to explore the differences in the prevalence, sociodemographic determinants, and effects of food insecurity between international and domestic students in an Australian university during the COVID-19 pandemic. MethodsThis study uses a cross-sectional online survey. The questionnaire contained the 18-item Household Food Security Survey Module to assess food security status. Logistic regression models were used to analyze the associations between student characteristics and food insecurity. A total of 467 students (376 domestic and 91 international) attending a large university in Sydney completed the survey between October 2021 and May 2022. ResultsCompared with domestic students (13.0% food insecure), international students (18.7% food insecure) had higher odds of being food insecure in our sample (odds ratio = 2.02; 95% CI, 1.01–4.07; P = 0.013). Different risk factors for food insecurity were identified in these two student groups (e.g., being undergraduates and living outside the parental home, for domestic students, and, for international students, living in accommodation that provided meals that did not suit their preferences and experiencing changes in living arrangements due to the pandemic). Lower fruit intake was reported by food-insecure domestic students. Poor well-being was reported by both food-insecure domestic and international students. International students with food insecurity were more likely to use food assistance services than food-insecure domestic students. ConclusionsInternational students experienced a higher risk of food insecurity than domestic students during the pandemic in Australia. More tailored interventions to address food insecurity need to be developed for international and domestic students by considering their different experiences.

Food Insecurity Disparities Among Immigrants in the U.S.

Food insecurity negatively impacts public health and costs the U.S. healthcare system $53 billion annually. Immigrants are at higher risk of food insecurity. We sought to (1) characterize the prevalence of food insecurity among immigrants (i.e., noncitizens and naturalized citizens) and U.S.-born citizens and (2) determine whether Supplemental Nutrition Assistance Program utilization and income-poverty ratio levels impact the relationship between immigration status and food insecurity. Multivariable logistic regression models were used to determine the odds of food insecurity (dependent variables) using nationally representative data from the 2019-2020 National Health Interview Survey. Independent variables included immigration status, Supplemental Nutrition Assistance Program utilization, income-poverty ratio, and other important demographics. AORs with their 95% CIs are reported. Analysis was conducted in 2022. After controlling for independent variables, noncitizens had 1.28 (95% CI=1.02, 1.61) times higher odds of food insecurity than U.S.-born citizens. There was no food insecurity disparity between naturalized citizens and U.S.-born citizens. However, the association between immigration status and food insecurity varied significantly at different levels of Supplemental Nutrition Assistance Program utilization and income-poverty ratio. There were no food insecurity disparities between immigrants and U.S.-born citizens when they utilized the Supplemental Nutrition Assistance Program and when they had an income below 200% federal poverty level. Noncitizens who did not utilize the Supplemental Nutrition Assistance Program or those with an income above 200% federal poverty level were more likely to report food insecurity than their U.S.-born counterparts (AOR=1.32, 95% CI=1.01, 1.73 and AOR=1.88, 95% CI=1.24, 2.86, respectively). Moreover, naturalized citizens with an income above 200% federal poverty level were also more likely to report food insecurity than their U.S.-born counterparts (AOR=1.61, 95% CI=1.21, 2.14). Supplemental Nutrition Assistance Program utilization may likely eliminate food insecurity disparities among immigrants and U.S.-born citizens. However, among non-Supplemental Nutrition Assistance Program utilizers, significant food insecurity disparities remained between noncitizens and U.S.-born citizens after adjusting for independent variables. In addition, among individuals with incomes above 200% federal poverty level, significant food insecurity disparities were observed between immigrants and U.S.-born citizens. More research is needed to further understand the role that fear of deportation, ineligibility or lack of awareness about eligibility for the Supplemental Nutrition Assistance Program, and other factors such as structural racism play in food insecurity disparities between immigrants and U.S.-born citizens.

Risk of financial stressors in patients diagnosed with cancer: Lessons from a nationwide financial navigation program.

e18662 Background: Financial toxicity associated with a cancer diagnosis exacerbates the financial crisis in cancer patients and their families. Financial crisis is associated with poor outcomes due to both non-medical and medical hardships. Family Reach, a US-based nonprofit, is dedicated to removing financial barriers standing between cancer patients and their treatment through comprehensive financial navigation. In this study, we sought to understand the prevalence of medical and non-medical financial stressors in a Family Reach cohort. Methods: Patient application data (provided by patients, caregivers, or case workers) from the Family Reach program received between March 2020 and June 2022 were included in the analysis. Data included patient demographics, clinical attributes, financial attributes, and medical and non-medical financial stressors (described below). Significant associations between stressors and patient characteristics [X2 test and Odds Ratios (OR)] are presented. Results: A total of 10,558 applications representing 50 states and D.C. were processed in the study period. Data was stratified by type of cancer (55% solid vs. 38% hematologic), age of patient (32% pediatric, 32% AYA, &amp; 36% adult), and patient race &amp; ethnicity [41% non-Hispanic White (W), 22% non-Hispanic Black (B), 16% Hispanic/Latinx (H/L)]. Ninety-two percent had annual household income &lt; $70,000 (US median -$70,784 in 2021). Race and ethnicity differences: Eighty-five percent B and 84% H/L patients had an annual household income &lt; $50,000, as compared to 65% W patients (X2p &lt; 0.05), and more likely to belong to single-parent households (59% B, 40% H/L, 30% W, X2 p &lt; 0.05). B and H/L patients were at a higher risk of food insecurity (B vs. W, OR = 1.8, H/L vs. W, OR = 1.9), utility shut-off (B vs. W, OR = 1.9, H/L vs. W, OR = 1.4), phone shut-off (B vs. W, OR = 2.0, H/L vs. W, OR = 1.2) and houselessness (B vs. W, OR = 1.8, H/L vs. W, OR = 1.7), compared to W patients, after adjusting for geography. Age of cancer onset: No income differences were observed between pediatric, AYA, &amp; adult patients. Adult (OR = 3.2) &amp; AYA (OR = 1.9) patients had a higher risk of unpaid medical expenses, as compared to pediatric patients, after adjusting for income &amp; geography. While no significant differences were noted between solid and heme cancers, lung patients were at a higher risk of financial distress from non-medical expenses (e.g., risk of homelessness OR = 1.4) as compared to breast, colon, and prostate combined, after adjusting for income &amp; geography. Conclusions: To our knowledge, this is the first analysis of financial stressors in a US national cohort of cancer patients and receiving financial navigation. The higher prevalence of financial stressors in patients of color in this self-selected group indicates that interventions addressing cancer need to integrate social determinants of health.

Prevalence of food insecurity and its association with depressive and anxiety symptoms in older adults during the COVID-19 pandemic in Mexico: A secondary analysis of ENCOVID-19 survey.

COVID-19 infection has caused high rates of morbi-mortality in older adults (OAs). In addition, conditions such as depression, anxiety, unemployment, and poverty frequently contribute to this population being at higher risk of food insecurity (FI) during the COVID-19 pandemic. This study aimed to analyze the prevalence of FI and its association with depressive and anxiety symptoms in Mexican OAs during the COVID-19 pandemic. This study involved a secondary analysis of the National Survey on the Effects of COVID-19 on the Wellbeing of Mexican Households (ENCOVID-19), a series of cross-sectional telephone surveys conducted between April and October 2020. The OA subsample was 1,065. FI was measured by using the Latin American and Caribbean Food Security Scale (ELCSA), and depression and anxiety symptoms were measured by using the Depression Scale of the Center for Epidemiological Studies (CESD-7) and the Generalized Anxiety Disorder Scale (GAD-2), respectively. Socioeconomic status (SES), occupation, schooling, and pension were also evaluated. ANOVA was used to compare the variables between the different FI groups, and logistic regression was used to analyze the risk between FI and the anxiety and depression variables. The mean age of the participants was 67.31 ± 6.4 years, and FI was classified as mild, moderate, and severe, with prevalences of 38.6, 15.04, and 8.16%, respectively. Overall, 28.01% of the OAs presented symptoms of anxiety and 39.09% of depression. In the comparison between groups, a higher prevalence of depressive symptoms was observed with a higher degree of FI, with 65.75% in moderate-to-severe, 10.39% in mild, and 9.40% without FI, p ≤ 0.000. Regarding anxiety symptoms, 48% of the OAs showed moderate-to-severe, 30.05% showed mild, and 15.38% were without FI, p ≤ 0.000. Using multiple logistic regression, an OR of 5.50 (95% CI 2.74-11.04) was observed for depressive symptoms when moderate-to-severe FI is present. In the case of the risk of anxiety symptoms, it was significant in all degrees of FI, in mild (OR = 2.43, 95% CI 1.66-3.59) and in moderate-to-severe (OR = 5.32, 95% CI 3.45-8.19). There is a high prevalence of FI in Mexican OAs during the COVID-19 pandemic. FI increases the risk of other conditions such as depression and anxiety. It is important to design and implement programs aimed at OAs with these conditions to reduce or prevent FI.

Indigenous knowledge in traditional production of rice: Impact on food security in the upland households in Ifugao, Philippines

Indigenous knowledge is essential to the survival of highland farming across the world. In the Philippines, the Ifugao indigenous people have a long history of rice farming which is intertwined with their indigenous knowledge and cultural identity, particularly the Ifugao Rice Terraces (IRT). Their traditional practices of rice production entails the use of indigenous knowledge. The investigation included a number of conventional processes, ranging from land preparation through harvesting and even the planting season. It is clear that Ifugaos continue to grow native rice in the region in the customary manner. It is noteworthy because Ifugao is having food security challenges, thus 82 percent of people believe that there is a high risk of food insecurity, and 70.20 percent believe that rice output is insufficient based on yearly rice production. 51.2 percent felt that even though there is food insecurity, they would not go hungry.

Do Patients Reporting Fractures Experience Food Insecurity More Frequently Than the General Population?

The economic burden of traumatic injuries forces families into difficult tradeoffs between healthcare and nutrition, particularly among those with a low income. However, the epidemiology of food insecurity among individuals reporting having experienced fractures is not well understood. (1) Do individuals in the National Health Interview Survey reporting having experienced fractures also report food insecurity more frequently than individuals in the general population? (2) Are specific factors associated with a higher risk of food insecurity in patients with fractures? This retrospective, cross-sectional analysis of the National Health Interview Survey was conducted to identify patients who reported a fracture within 3 months before survey completion. The National Health Interview Survey is an annual serial, cross-sectional survey administered by the United States Centers for Disease Control, involving approximately 90,000 individuals across 35,000 American households. The survey is designed to be generalizable to the civilian, noninstitutionalized United States population and is therefore well suited to evaluate longitudinal trends in physical, economic, and psychosocial health factors nationwide. We analyzed data from 2011 to 2017 and identified 1399 individuals who reported sustaining a fracture during the 3 months preceding their survey response. Among these patients, 27% (384 of 1399) were older than 65 years, 77% (1074) were White, 57% (796) were women, and 14% (191) were uninsured. A raw score compiled from 10 food security questions developed by the United States Department of Agriculture was used to determine the odds of 30-day food insecurity for each patient. A multivariate logistic regression analysis was performed to determine factors associated with food insecurity among patients reporting fractures . In the overall sample of National Health Interview Survey respondents, approximately 0.6% (1399 of 239,168) reported a fracture. Overall, 17% (241 of 1399) of individuals reporting broken bones or fractures in the National Health Interview Survey also reported food insecurity. Individuals reporting fractures were more likely to report food insecurity if they also were aged between 45 and 64 years (adjusted odds ratio 4.0 [95% confidence interval 2.1 to 7.6]; p < 0.001), had a household income below USD 49,716 (200% of the federal poverty level) per year (adjusted OR 3.1 [95% CI 1.9 to 5.1]; p < 0.001), were current tobacco smokers (adjusted OR 2.8 [95% CI 1.6 to 5.1]; p < 0.001), and were of Black race (adjusted OR 1.9 [95% CI 1.1 to 3.4]; p = 0.02). Among patients with fractures, food insecurity screening and routine nutritional assessments may help to direct financially vulnerable patients toward available community resources. Such screening programs may improve adherence to nutritional recommendations in the trauma recovery period and improve the physiologic environment for adequate soft tissue and bone healing. Future research may benefit from the inclusion of clinical nutritional data, a broader representation of high-energy injuries, and a prospective study design to evaluate cost-efficient avenues for food insecurity interventions in the context of locally available social services networks. Level III, prognostic study.