Household Food Security Module Research Articles

Food Security: An Unmet Need in Outpatient Burn Care.

Nutrition is paramount for wound healing after burn injury. With rising food prices and time off work due to burn injuries, access to adequate nutrition may be a significant financial stressor. We asked patients at an outpatient burn clinic to complete the Household Food Security Module, which queries about food security over the preceding 12 months. Demographics and burn characteristics were abstracted from the medical record. We assessed the overall prevalence of food insecurity, risk factors for food insecurity, and potential effects of food insecurity on nutritional status and wound healing time. Wound healing time was assessed via Cox regression while adjusting for burn depth, total body surface area burned, and diabetes. Over 40% of participants reported experiencing food insecurity; it was more common in patients who preferred Spanish language (p=0.014) or were unemployed (p=0.049). Just over half of participants experiencing food insecurity were using any food assistance resources. Among patients more than 30 days from burn injury, patients who were food insecure had larger burns (p=0.01). Experience of food insecurity was not associated presence of malnutrition on nutrition-focused physical exam (p=0.47). Wound healing time for burns managed in the outpatient setting was associated with burn depth (p<0.001), but not food insecurity (p=0.95), burn size (p=0.17), or diabetes (p=0.14). Although food insecurity did not result in malnutrition or negatively impact wound healing time, it is important for providers to routinely screen for food insecurity due to increased nutritional requirements and loss of wages after burn injury.

Public assistance, living environments, and food insecurity: A comparative community case study

Food insecurity continues to affect certain seg­ments of the U.S. population at the household and individual levels even when the economy is experi­encing growth. This recognition has led to the design and implementation of food assistance programs, such as the Supplemental Nutrition Assistance Program, targeting food hardship in low-income families. This is in addition to other types of government assistance, such as housing subsidies and public housing, as low-income households and individuals face similar challenges in housing security. Concern over “concentrated poverty” in traditional public housing environment has contributed to a shift toward mixed-income developments, envisaged to improve the living conditions and economic opportunities of public-housing residents. This paper provides a compara­tive assessment of food insecurity in traditional and mixed-income public housing communities. It also examines the effect of nonhousing public assis­tance on food insecurity and the temporal relation­ship between the timing of food hardship and the receipt of assistance. Administering a modified version of the U.S. Department of Agriculture (USDA)’s Household Food Security Module to the majority of residents in the two communities, the researchers found negligible differences in food insecurity between recipients and nonrecipients of government assistance. Nevertheless, government assistance appeared to improve the probability of being food secure as it interacted with living envi­ronments, suggestive of greater beneficial effect in the environment of mixed-income housing. The results show that the number of households experi­encing reduced food intake was lowest in the first two weeks and highest during the fourth week of the month.

Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older

Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association. To examine whether food insecurity in older adults is associated with later-life cognitive outcomes. This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023. Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure. Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights. The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline. In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.

Prenatal Risks to Healthy Food Access and High Birthweight Outcomes

ObjectiveInfants with high birthweight have increased risk for adverse outcomes at birth and across childhood. Prenatal risks to healthy food access may increase odds of high birthweight. We tested whether having a poor neighborhood food environment and/or food insecurity had associations with high birthweight. MethodsWe analyzed cross-sectional baseline data in Greenlight Plus, an obesity prevention trial across six US cities (n = 787), which included newborns with a gestational age greater than 34 weeks and a birthweight greater than 2500 g. We assessed neighborhood food environment using the Place-Based Survey and food insecurity using the US Household Food Security Module. We performed logistic regression analyses to assess the individual and additive effects of risk factors on high birthweight. We adjusted for potential confounders: infant sex, race, ethnicity, gestational age, birthing parent age, education, income, and study site. ResultsThirty-four percent of birthing parents reported poor neighborhood food environment and/or food insecurity. Compared to those without food insecurity, food insecure families had greater odds of delivering an infant with high birthweight (adjusted odds ratios [aOR] 1.96, 95% confidence intervals [CI]: 1.01, 3.82) after adjusting for poor neighborhood food environment, which was not associated with high birthweight (aOR 1.35, 95% CI: 0.78, 2.34). Each additional risk to healthy food access was associated with a 56% (95% CI: 4%−132%) increase in high birthweight odds. ConclusionsPrenatal risks to healthy food access may increase high infant birthweight odds. Future studies designed to measure neighborhood factors should examine infant birthweight outcomes in the context of prenatal social determinants of health.

Is intuitive eating a privileged approach? Cross-sectional and longitudinal associations between food insecurity and intuitive eating.

To examine: (1) cross-sectional and longitudinal associations between measures of food insecurity (FI; household status and youth-reported) and intuitive eating (IE) from adolescence to emerging adulthood; and (2) the association between FI persistence and IE in emerging adulthood. Longitudinal population-based study. Young people reported IE and FI (two items from the US Household Food Security Module) in adolescence and emerging adulthood. Parents provided data on household FI via the six-item US Household Food Security Module in adolescence. Adolescents (Mage = 14·3 ± 2 years) and their parents, recruited from Minneapolis/St. Paul public schools in 2009-2010 and again in 2017-2018 as emerging adults (Mage = 22·1 ± 2 years). The analytic sample (n 1372; 53·1 % female, 46·9 % male) was diverse across race/ethnicity (19·8 % Asian, 28·5 % Black, 16·6 % Latinx, 14·7 % Multiracial/Other and 19·9 % White) and socio-economic status (58·6 % low/lower middle, 16·8 % middle and 21·0 % upper middle/high). In cross-sectional analyses, youth-reported FI was associated with lower IE during adolescence (P = 0·02) and emerging adulthood (P < 0·001). Longitudinally, household FI, but not adolescent experience of FI, was associated with lower IE in emerging adulthood (P = 0·01). Those who remained food-insecure (P = 0·05) or became food-insecure (P = 0·02) had lower IE in emerging adulthood than those remaining food-secure. All effect sizes were small. Results suggest FI may exert immediate and potentially lasting impacts on IE. As evidence suggests IE is an adaptive approach conferring benefits beyond eating, it would be valuable for interventions to address social and structural barriers that could impede IE.

Association between food insecurity and kidney stones in the United States: Analysis of the National Health and Nutrition Examination Survey 2007-2014.

Although food insecurity is a major public health concern associated with various diseases, the relationship between food insecurity and kidney stones remains unclear. We aimed to investigate the association between food insecurity and kidney stones in the US population. Four continuous cycles of data from the year 2007 to 2014 were obtained from National Health and Nutrition Examination Survey (NHANES) in the current study. We utilized the Household Food Security Module to assess the food security status of individuals. The primary outcome was whether participants ever had kidney stones, and the secondary outcome was a stone recurrence. A multivariate logistic regression model adjusting for potential confounders was constructed to evaluate the independent association between food insecurity and kidney stones. A total of 21,914 participants were included in our analysis, with 8.8% having a history of kidney stones and 33.2% of these reporting stones recurrence. Food insecurity was associated with increased risks of kidney stones (odds ratio: 1.21; 95% confidence interval: 1.05-1.39; P = 0.010) and kidney stones recurrence (odds ratio: 1.33; 95% confidence interval: 1.00-1.77; P = 0.052) after adjusting for all potential confounders. In addition, participants with very low food security had 38% and 47% higher risks of kidney stones (odds ratio: 1.38; 95% confidence interval: 1.13-1.69; P = 0.002; P for trend = 0.009) and kidney stones recurrence (odds ratio: 1.47; 95% confidence interval: 1.03-2.10; P = 0.032; P for trend = 0.029), respectively. There exists a significant association between food insecurity and kidney stones, which reveals the significance of the improvement of food insecurity in the alleviation of kidney stone formation and recurrence.

Food Insecurity May be an Independent Risk Factor Associated With Erectile Dysfunction in the United States: Analysis of the National Health and Nutrition Examination Survey Data.

IntroductionWhile food insecurity is a global public health problem associated with obesity, diabetes, hypertension and coronary heart disease, literature regarding the relationship between food insecurity and erectile dysfunction (ED) is scarce.AimWe aimed to determine the associations between food insecurity and ED in the National Health and Nutrition Examination Survey.MethodsData was extracted from 3,891 participants (aged ≥ 20 years) with ED in the 2001–2004 National Health and Nutrition Examination Survey. Multivariable logistic regression analysis with sampling weights was conducted to evaluate the associations.Main outcome measureFood security was assessed utilizing the Household Food Security Module. A single-question self-report from the Massachusetts Male Aging Study was utilized to evaluate ED status.ResultsApproximately 10.2% of individuals had food insecurity. Food insecurity was significantly associated with ED after full adjustment (odds ratio [OR] 1.56; 95% confidence interval [95% CI] 1.16–2.09; P = .003). Men with very low food insecurity had 59% higher risks of ED compared with those having high food security (OR 1.59; 95% CI 1.13–2.27; P = .006). Moreover, the associations were stronger in the old people (age ≥ 60) (OR 2.15; 95% CI 1.26–3.66; P = .004).ConclusionsFood insecurity might be associated with higher risks of developing ED.Wang W, Chen J, Peng L, et al. Food Insecurity May be an Independent Risk Factor Associated With Erectile Dysfunction in the United States: Analysis of the National Health and Nutrition Examination Survey Data. Sex Med 2022;10:100549.

Food Insecurity and Diabetes: Evidence of Psychosocial Consequences During the COVID-19 Pandemic in the United States

ObjectivesTo analyze the associations between food insecurity (FI) and diabetes distress (DD) related to COVID-19 in adults with pre-diabetes/diabetes in the United States (US). MethodsWe fielded a national, web-based survey among low-income adults in the US (N = 1,756). Measures included FI status, using the 18-item USDA Household Food Security Module, and DD, using the 17-item Diabetes Distress Scale. Multinomial logistic regression models examined the relationship between FI and DD among adults with pre-diabetes, type-1, or type-2 diabetes (n = 317). ResultsOverall, 58.4% of participants reported little/no distress, 15.7% reported moderate distress and 25.9% reported high distress. Adults with FI had a higher prevalence of high DD (43.3% vs. 13.5%) and moderate DD (23.3% vs. 11.9%) compared to individuals with food security (p < 0.001). Compared to individuals with food security, individuals experiencing FI had clinical levels of distress (moderate or high) for the emotional burden subscale (70.4% vs. 27.7%), regimen-related subscale (71.4% vs. 34.7%), interpersonal subscale (23.6% vs. 58.64% vs. 23.6%) and physician-related subscale (57.4% vs. 17.1%). ConclusionsDuring the COVID-19 pandemic, FI was associated with higher DD among individuals with pre-diabetes/diabetes in the US. Healthcare providers should screen for DD and connect patients to resources to help manage their food and mental health needs. Funding SourcesThis research was supported by a grant from Poverty Solutions at the University of Michigan. In addition, JAW was supported by the National Institutes of Diabetes and Digestive And Kidney Diseases of the National Institutes of Health (Award #K01DK119166) and CWL was supported by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (Award #4R00HD084758). HP was funded as a Sight and Life Scholar by the Sight and Life Global Nutrition Research Institute.

Food Insecurity Is Associated With a Lower Quality of Life Among People Living With HIV (PLWH) and HIV Seronegative Individuals, in the Miami Adult Studies on HIV (MASH) Cohort

ObjectivesFood insecurity affects underserved and marginalized populations in the United States, which could lead to a decline in quality of life over time and further worsening health outcomes. This study aims to determine the association between food security and quality of life among people living with and without HIV in Miami, FL. MethodsThis was a cross-sectional analysis of a minority population from the Miami Adult Studies on HIV (MASH) cohort. Demographics, anthropometrics, and fasting blood samples were collected by trained personnel. HIV viral loads (VL, copies/ml) were abstracted from medical records (suppressed viral load < 50 copies/ml) with the participants’ consent. Food security status was assessed using the USDA Household Food Security Module and analyzed as food secure (full) vs. insecure (marginal, low, very low). Quality of Life (QoL) was determined with the Spitzer QoL Index (scores: 0–10). QoL was dichotomized as a high (≥8) or low QoL (<8). All statistical analyses were performed using SPSS 26. ResultsParticipants’ mean age was 54.6 ± 7.9 years (N = 1,034), 58% were male, and 61.1% Black; 46.6% were living with HIV and 90.9% had a suppressed viral load. Food insecurity was reported by 48.4% of individuals. Food secure individuals showed a significantly higher QoL score compared to food insecure individuals (8.68 ± 1.57, 7.84 ± 1.89, respectively; p < 0.001). People living with HIV (PLWH) did not have significantly different QoL scores nor food insecurity compared to HIV-uninfected individuals. A linear regression showed that food security was associated with higher QoL after adjusting for age, sex, race, ethnicity, HIV status, BMI, and annual family income (β = 0.64 SE = 0.11, P = 0.001). Logistic regression found that food insecurity was associated with lower odds of having a high QoL after adjusting for age, sex, race and ethnicity, HIV status, BMI, and annual family income (OR: 0.45; 95% CI: 0.33, 0.62; P < 0.001). ConclusionsFood insecurity negatively affects the quality of life of minorities with and without HIV in the MASH cohort in Miami. Improving the food security of marginalized populations by facilitating their access to high-quality foods could improve their health and quality of life. Funding SourcesNational Institute on Drug Abuse.

Risk of food insecurity in undocumented migrant households in Birmingham, UK.

This study aimed to understand the extent of household food insecurity amongst undocumented migrant families in Birmingham,UK. Cross-sectional survey of households (n=74) with dependent children using the USDA 18-item household food security (HFS) module. All households had an irregular immigration status and were accessing an immigration advice drop-in service (n=98 adults; n=138 children) in Birmingham. About 95.9% of households were food insecure, and 94.6% of children lived in households with low or very low food security. Food insecurity varied within households. Around 91.8% of adults were food insecure, compared to 75.6% of children. Spearman's rank-order correlation indicated a statistically significant positive correlation between household food insecurity level and number of children (rho=0.253, P=0.031). A Kruskal-Wallis H Test indicated no statistically significant difference (P=0.730) in HFS score between households supported by asylum support, children's social services or paid employment in the informal economy and those that had no regular income. Prevalence of HFS was higher in this sample of undocumented migrant households with dependent children in Birmingham, UK, than in the wider population, and larger households were more food insecure. Households without a regular income were no more likely to be food insecure than households with financial support.

Analysis of Food Security Status of Fishermen's Households on Kulisusu District North Buton Regency

This study aims to determine the level of household food security in coastal communities. The research was carried out in 2020 in Lantagi Village, Kulisusu District, North Buton Regency. Samples were taken by simple random sampling with a total sample of 35 people. The data analysis used is descriptive quantitative and analysis of food security status using the household food security module developed by the United States Development of Agriculture. The results showed that the level of household food security status of coastal communities was low. This is because most of the fishermen in the research location are classified as poor, and their source of income only relies on fishing activities. Where fishing activities in the sea are also very dependent on traditional fishing gear, sea conditions, waves, weather/seasons. The steps usually taken by fishermen when facing low-income situations so that household food availability remains adequate are buying cheaper food, reducing food consumption, and sometimes borrowing money from family or neighbors.

Food insecurity is associated with higher food responsiveness in low-income children: The moderating role of parent stress and family functioning.

Food insecurity (FI) may increase the odds for childhood obesity, yet little is known about the mechanism explaining this relationship. Parents experience greater psychosocial stress in the context of FI. In these environments, children from FI households may exhibit different appetitive behaviours. To examine associations between FI and appetitive behaviours in children (3-5 years) and to explore whether social, emotional and structural properties of the home environment moderate this relationship. In a low-income sample of 504 parent-child dyads, parents completed the household food security module and the Children's Eating Behavior Questionnaire. A subsample (n=361) self-reported perceived stress, depressive symptoms, household chaos and family functioning. Children were categorized as food secure, household FI and child FI. Food responsiveness (LSmeans ± SE; child FI: 2.56 ± 0.13; food secure: 2.31 ± 0.10, p < 0.05) and emotional overeating (LSmeans ± SE; child FI: 1.69 ± 0.10; food secure: 1.48 ± 0.08, p < 0.05) were higher among children in the child FI group compared to the food secure group. Child FI was only associated with higher food responsiveness among children of parents reporting high levels of perceived stress (p=0.04) and low levels of family functioning (p=0.01). There were no differences in food responsiveness by food security status at mean or low levels of perceived stress or at mean or high levels of family functioning (p > 0.05). Child FI may contribute to obesity risk through differences in appetitive behaviours. For low-income families, stress management and improving family dynamics may be important factors for interventions designed to improve children's appetitive behaviours.

Examining Factors Related to the Food Insecurity-Obesity Paradox in Low-Income Mothers and Fathers.

Prior research has indicated a varying relationship of food security and obesity risk between men and women yet factors affecting this relationship are unclear. The objective of this study was to examine factors related to the gender disparity in the food insecurity-obesity paradox within a sample of low-income parents. Low-income cohabiting mother and father pairs (n = 25) living with their child were interviewed individually using the United States Department of Agriculture Household Food Security Module, Center for Epidemiological Studies Depression Scale, and Coping Strategies Index to examine gendered factors related to the food insecurity-obesity paradox. There was a significant (P = .003) difference in report of adults in the household sacrificing consumption to feed young children between mothers (2.91 ± 0.92) and fathers (3.59 ± 0.73), with mothers reporting greater sacrifice and compromised diet quality to feed their children, but no significant correlation among body mass index, depression, and food insecurity was detected. Food insecure mothers may be more likely to compromise their diet quality to feed their children than fathers. This could help explain why the food insecurity-obesity paradox is significant only in women, and this work gives insights into gender-based differential consequences of food insecurity.

Food Insecurity and Cognitive Impairment in the Miami Adult Studies on HIV (MASH) Cohort

Food insecurity is a social determinant of health associated with cognitive impairments in older adults and people living with HIV (PLWH). Few studies have examined this relation longitudinally, and no studies have explored how the frequency of food insecurity over time may impact cognitive impairment. This study aimed to examine the impact of food insecurity on cognitive impairment over a 2-y follow-up period in a cohort of people living with and without HIV. This was a 2-y longitudinal analysis of primarily economically disadvantaged, middle-aged, Black, and Hispanic participants from the Miami Adult Studies on HIV (MASH) cohort. Food insecurity was assessed with the USDA Household Food Security Module at baseline and 12- and 24-mo follow-ups. Food insecurity in all 3 assessments was considered persistent food insecurity. Cognitive impairment was assessed with the Mini-Mental State Examination. Statistical analyses consisted of logistic regressions. A total of 394 participants (247 HIV positive) with 2-y follow-up data were included in this analysis. At baseline, 104 (26.4%) were food-insecure and 58 (14.7%) had cognitive impairment. Very low food security was associated with cognitive impairment at baseline (OR: 3.23; 95% CI: 1.08, 9.65). PLWH not virally suppressed had higher risk for cognitive impairment compared with HIV-uninfected participants (OR: 2.87; 95% CI: 1.15, 7.18). Additionally, baseline food insecurity (OR: 2.28; 95% CI: 1.08, 4.81) and the frequency of food insecurity over time (OR: 1.50 per year; 95% CI: 1.08, 2.10), particularly persistent food insecurity (OR: 3.69; 95% CI: 1.15, 11.83), were associated with cognitive impairment at 2-y follow-up; the results were consistent after excluding cognitively impaired participants at baseline. Food insecurity is a significant risk factor for cognitive impairment, particularly among individuals who experience food insecurity frequently or persistently. Screening for food insecurity and interventions to secure access to sufficient, nutritious foods may help delay cognitive decline among socioeconomically disadvantaged individuals.

Food Insecurity Is Associated with Depression, Anxiety, and Stress: Evidence from the Early Days of the COVID-19 Pandemic in the United States.

Purpose: To understand associations between food insecurity and depression, anxiety, and stress during the COVID-19 pandemic among low-income adults in the United States.Methods: During March 19–24, 2020, we fielded a national, web-based survey (53% response rate) among low-income adults (<250% of the federal poverty line) in the United States (N=1,476). Food security status was measured using the 18-question USDA Household Food Security Module. Multivariable-adjusted logistic regression models examined the association between food insecurity and psychological distress outcomes and COVID-19-specific worries. Qualitative data from an open-response question were also analyzed.Results: More than one-third of low-income adults screened positive for depression (33%), anxiety (39%), and high stress (39%). Greater food insecurity was associated with a dose–response relationship with all psychological distress outcomes (all outcomes p-trend <0.001) and COVID-19-specific worries (all outcomes p-trend <0.001). Compared to food-secure adults, adults with very low food security were more likely to screen positive for depression (odds ratio [OR] 7.72; 95% confidence interval [CI]: 5.52–10.80), anxiety (OR 6.19; 95% CI: 4.51–8.51), and high perceived stress (OR 10.91; 95% CI: 7.78–15.30). Very low food security was also associated with increased worries about the effect of COVID-19 on one's health (OR 2.56; 95% CI: 1.90–3.45), income (OR 5.18; 95% CI: 3.78–7.06), and ability to feed one's family (OR 9.24; 95% CI: 6.61–12.92).Conclusions: The COVID-19 pandemic is negatively associated with the mental health of low-income adults in the United States, with disproportionate associations among adults experiencing food insecurity. These disparities have the potential to increase mental health disparities over the long term.

A pilot examination of the inter-rater reliability of the 18-item Household Food Security Module between cohabiting mothers and fathers.

Food insecurity, defined as the inability to access sufficient food for an active, healthy life, affects 11.1% of the US population and is primarily assessed using the United States Department of Agriculture's (USDA) 18-item Household Food Security Survey Module (HFSSM). The HFSSM is a self-report measure presumed to represent all household members, but it is unknown if cohabiting parents report food security differently. This pilot study aimed to determine (i) the inter-rater reliability of the HFSSM; (ii) the direction of any difference between responses to the HFSSM; and (iii) the item-level response similarities and differences among mothers and fathers of young children. Twenty-five pairs of low-income, food-insecure cohabiting parents of 2.5- to 10-year-old children participated in cognitive interviews assessing their level of food security using the USDA's HFSSM and completed related questionnaires. Intraclass correlations were computed to compare the responses of each dyad on the HFSSM overall and by item. Results revealed that overall report of food security was significantly but weakly correlated (r = .40, p = .02) within dyads. The majority of fathers (60%) reported higher food security scores on the HFSSM than their respective female partners. Furthermore, item-level intraclass correlations revealed that some HFSSM questions had poor reliability between cohabiting parents. This research identifies that a potential shortcoming of the HFSSM is the under-reporting of food insecurity by fathers compared with mothers within the household. These findings have implications for the utility of this measure used in national monitoring of the nation's food security.

Prevalence, socio-economic predictors and health correlates of food insecurity among Italian children- findings from a cross-sectional study

Considering food insecurity is a problem, even in developed countries, and the evidence gap regarding this issue in Italy, we aimed to assess the prevalence of food insecurity in a sample of Italian children and examine socio-economic and health correlates. This cross-sectional study was conducted in paediatric practices. Parents answered to the 18-items of the Household Food Security Module, 8 of which concern children. Paediatricians answered a questionnaire on children’s health. Socio-economic and health correlates of food insecurity in children were assessed using univariable and multivariable logistic regression. Among 573 households with children, 15·4% were food insecure, while 9·1% of children were food insecure. Socio-economic factors associated to food insecurity were living in south Italy, households with three or more children, lower household yearly income, worse economic situation description and younger parents. Food insecure children were less likely to have a normal relational [ aOR 0.31 (CI 0.11-0.85)] and physical development [aOR 0.32(CI 0.15-0.65) and had more school difficulties [aOR 3.1(CI 1.33-7.24)] compared to their food secure peers. Food insecure children had higher odds of a deterioration in their health since birth and of a worse perceived health status, as reported by their parents. Considering the results in this sample and the lack of research regarding this issues in Italy and Europe more broadly, we call for consistent, national monitoring to determine the magnitude of the problem of food insecurity in households with children in Italy and to examine the socio-economic variables and health implications in different contexts.

P117 Household Food Insecurity Does Not Predict Weight-Related Outcomes in a Low-Intensity Childhood Obesity Treatment Program

<h3>Background</h3> Food insecurity (FI) has been paradoxically associated with childhood obesity. Little research has examined whether FI influences response to childhood obesity treatment. <h3>Objective</h3> Conduct a secondary analysis examining effects of household FI status on weight-related outcomes among children participating in a low-intensity obesity treatment program delivered at a federally qualified health center (FQHC). <h3>Study Design, Setting, Participants</h3> Two 6-month family-based programs targeting energy-balance behaviors were implemented. One program targeted caregiver and child behaviors, while the other targeted child behaviors only. Children 4-10 years, body mass index (BMI) ≥85th percentile, receiving integrated primary care at the FQHC, and with a female caregiver were randomized to 1 of the 2 programs. The program consisted of alternating monthly in-person meetings and phone calls delivered by a licensed behaviorist in primary care. <h3>Measurable Outcome/Analysis</h3> Household FI status at 0 months was determined by the U.S. Household Food Security Module. At months 0 and 6, measured anthropometrics were used to calculate BMI z-score (zBMI), and energy intake (EI) was assessed via three 24-hour dietary recalls. Regression analyses, controlling for randomization and 0-months zBMI or EI, examined if FI status predicted post-intervention zBMI or EI. Repeated measures controlling for the randomized group examined the main effect of time on zBMI and EI. <h3>Results</h3> Sixty-six children (8.2 ± 1.8 years, 59% male, 91% White, 77% Hispanic/Latino, 35% FI) were included in analysis. FI status was not related to zBMI, t(62) = 1.01, <i>P</i> = 0.32, or EI, t(48) = 0.44, <i>P</i> = .66, at post-intervention. A main effect of time was observed for zBMI (2.01 ± 0.42 vs 1.94 ± 0.47), F(1,64) = 5.97, <i>P</i> = .017, and EI (1172 ± 454 kcal vs 1021 ± 196 kcal), F(1,50) = 6.86, <i>P</i> = .012. <h3>Conclusions</h3> FI status did not affect weight-related outcomes in this low-intensity obesity treatment program. Future research should examine whether FI status affects outcomes in more intensive interventions for which adherence may be challenging for families with unstable food access.

Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity Among SNAP-Ed Eligible Head Start Families

Abstract Objectives To examine the associations between food resource management (FRM) self-confidence and behaviors that help maximize the use of food dollars by household food insecurity (HFI) status. Methods Cross-sectional survey on SNAP-Ed eligible Head Start families in Pennsylvania, US (n = 366). HFI status was assessed using the 18-item USDA Household Food Security Module. FRM self-confidence was measured using 5-questions (e.g., “How confident are you that you can buy healthy foods for your family on a budget?”) and FRM behaviors were assessed using 6-questions (e.g., “How often do you plan meals before shopping for groceries?”). The associations between FRM self-confidence and behavior by HFI status were explored using chi-square and simple logistic regression analyses. Results The average FRM self-confidence score of respondents was 3.02(SD: 0.71) and FRM behavior score was 3.7(SD: 0.8). Participants with high FRM self-confidence had lower odds of HFI (OR = 0.36, 95% CI: 0.23, 0.56, P &amp;lt; 0.001), yet the association between FRM behaviors with HFI status was not found to be statistically significant (P = 0.91). When individual FRM questions were explored, results showed that all FRM self-confidence questions significantly differed by HFI status (highest p-value &amp;lt; 0.046); e.g., a higher proportion of food secure households were moderately confident or very confident to buy healthy foods on a budget compared to food insecure households (75% vs 58%, P &amp;lt; 0.001). For individual FRM behaviors, one of the 6 behaviors differed by HFI status; food insecure households were more likely to report never or rarely using a shopping list when grocery shopping vs their food secure counterparts (12% vs 9%, P = 0.016). Conclusions Higher confidence in FRM skills may protect against food insecurity among SNAP-Ed eligible households. Nutrition education programs designed to assist low-income households in stretching their food dollars need to target self-confidence in FRM skills, and address what factors may affect their FRM behaviors, in an attempt to alleviate food insecurity. Funding Sources This material was funded by USDA's Supplemental Nutrition Assistance Program (SNAP) through the PA Department of Human Services (DHS). This institution is an equal opportunity provider.

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age.

To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations. Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors. Head Start pre-school classrooms in four regions across central Pennsylvania, USA. Low-income children of pre-school age (n 362) and their caregivers. Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6). Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.