Measures Of Food Insecurity Research Articles

Assessment of a Fruit and Vegetable Prescription Program in the Northern Manhattan Community

This study aimed to assess whether produce prescription redemption was associated with food insecurity (FI), sociodemographics, and nutrition-related health measures, and to identify factors affecting participation. Retrospective, cross-sectional study. Patients, equally divided between groups who redeemed and did not redeem prescriptions, completed a follow-up survey. Northern Manhattan, NY. 242 patients referred to Nutrition at an academic medical center between June and November 2019. All patients referred to Nutrition received prescriptions for produce at local Greenmarkets (patients with FI received $20; other patients received $10). We assessed patient satisfaction and factors impacting participation. Sociodemographics and nutrition-related health measures were extracted from medical records. The χ2 test for categorical data and Student's t-test for continuous variables. Prescription redeemers were significantly more likely to be very satisfied with the program (P < .001), have FI (P < .01), and have elevated hemoglobin A1C than non-redeemers (6.3 vs 5.5%, P < .001). Distance, time constraints, and forgetting or losing the prescription were common barriers, while convenience and valuing healthy eating facilitated redemption. Higher FI and worse hemoglobin A1c in patients who redeemed prescriptions suggests that our program reaches the target audience: patients needing food assistance and a healthier diet. Awareness of barriers offers areas for improvement. This provides a feasible model for hospital investment to increase access to produce to improve health and health equity.

Applying a Health Access Framework to Understand and Address Food Insecurity.

The prevalence of food insecurity (FI) in United States households has fluctuated between 10% and 15% for the past two decades, well above the Healthy People 2030 goal. FI is associated with increased use of healthcare services and the prevalence of multiple health conditions. Our current efforts to address FI may be limited by measures that lack granularity, timeliness, and consideration of larger food access barriers (e.g., availability of food providers and lack of knowledge regarding where to obtain food). If the Healthy People 2030 goal of reducing FI to 6% is to be met, we need better and faster methods for monitoring and tracking FI in order to produce timely interventions. In this paper, we review key contributors of FI from an access barrier perspective, investigate the limitations of current FI measures, and explore how data from one nonprofit organization may enhance our understanding of FI and facilitate access to resources at the local level. We also propose a conceptual framework illustrating how nonprofit organizations may play an important role in understanding and addressing FI and its intertwined social needs, such as housing and healthcare problems.

Food Insecurity Measurement: Stakeholder Comparisons of the EU-SILC and HFSSM Indicators and Considerations Towards the Usefulness of a Headline Indicator

Prior to the February 2019 announcement that the Household Food Security Survey Module (HFSSM) will be used to estimate household food insecurity, there has not been a standardised measurement approach used in the United Kingdom (UK). Measurement has instead been somewhat inconsistent, and various indicators have been included in national and regional surveys. There remains a gap relating to the comparative usefulness of current and past food insecurity measures used in Northern Ireland (NI) (HFSSM; European Union-Survey of Income and Living Conditions (EU-SILC) food deprivation questions), and the potential usefulness of a headline indicator similar to that used to measure fuel poverty. This study presents findings from Northern Ireland (NI) stakeholder interviews (n = 19), which examined their perspectives on food insecurity measures which have previously been or are currently, or could potentially, be used in the UK/NI (HFSSM; EU-SILC food deprivation questions; headline indicator). Interview transcripts were coded using QSR NVivo (v.12) and inductively analysed to identify relevant themes. Stakeholders preferred the HFSSM to the EU-SILC, reasoning that it is more relevant to the food insecurity experience. A headline indicator for food insecurity was considered useful by some; however, there was consensus that it would not fully encapsulate the food insecurity experience, particularly the social exclusion element, and that it would be a complex measure to construct, with a high degree of error. This research endorses the use of the HFSSM to measure food insecurity in the UK, and provides recommendations for consideration of any future modification of the HFSSM or EU-SILC measurement instruments.

Food insecurity is associated with eating disorders independent of depression and anxiety: Findings from the 2020-2021 Healthy Minds Study.

To examine the association between food insecurity and eating disorder (ED) risk independent of co-occurring anxiety/depression. Data were provided by 121,627 undergraduate/graduate students who participated in the 2020-2021 Healthy Minds Study (HMS). Participants responded to questionnaire measures of food insecurity and risk for EDs, depression, and anxiety. Established cut-offs were used to identify students with food insecurity and probable psychopathology. Separate modified Poisson regressions adjusted for age, gender, race/ethnicity, and socioeconomic background examined the association between food insecurity and each form of psychopathology. The association between food insecurity and probable ED was then examined in a regression further adjusted for probable depression and anxiety. Food insecurity was significantly associated with all three forms of psychopathology when examined separately (prevalence ratios ranged from 1.41 to 1.54, all p's < .001). When accounting for probable depression/anxiety, food insecurity was significantly associated with 1.19 times greater prevalence of a probable ED (p < .001). The association between food insecurity and EDs was replicated in a large, national sample of university students. To our knowledge, this is the first study to examine the independence of this relationship after adjusting for depression/anxiety. This finding supports the hypothesis that specific mechanisms, rather than general psychological distress, likely underlie the food insecurity-ED relationship.

Living in the flood plain: Can financial inclusion, productive assets and coping mechanism help reduce food insecurity?

Frequency of extreme events and natural disasters such as floods are increasing globally and affect food security of people living in affected areas. Using household survey data from extremely flood prone districts of Bihar, India, we examine the effect of financial inclusion, household productive assets, and coping strategies to reduce food insecurity in Koshi river basin. Controlling for a host of covariates and using alternative measures of food insecurity, we find that financial inclusion, mostly having a saving account in a bank, helps reducing the probability of food shortage by 21–31% (4.5–6.6 percentage points from the sample mean of 21%), and number of days households worried about food shortage reduces by 29–35% (0.62 days less from the sample mean of 1.77 days in a month), but access to credit, which has been one of the key focus of financial inclusion, is not effective to address the issue. These results are robust to alternative specification of the main model and different measures of food insecurity. Our results provide implementable policy recommendation that providing support to rural farmers for having a saving account and ownership of productive assets including livestock would be the short-term measures while incentivizing poor households for sending their children to school would be a long-term strategy as education is one of the important determinants of food security via earning.

Food insecurity and coping strategies in international migrants in transit through Mexico

BackgroundAlthough migrants in transit through Mexico have been known to consume insufficient food, data measuring food insecurity (FI) in this vulnerable population is scarce. This study assesses FI in migrants transiting Mexico by examining economic, physical and social food access. MethodsUsing a mixed-methods design and a convenience sample of migrants residing in a temporary shelter in Saltillo, Coahuila in northern Mexico, we applied 1) the Food Insecurity Experience Scale (adapted), and 2) a semi-structured interview exploring FI coping strategies. ResultsOf the 54 participants, 74.1% reported moderate or severe FI and 24.1% reported severe FI, especially reduced food quantity. Interviewees reported poverty, cargo train travel, and crime as FI contributing factors. All interviewees used FI coping strategies, principally altering food intake and using social resources. Many strategies reported implied negative consequences for both nutrition and general health. ConclusionsThis study provides a comprehensive assessment of FI in a mobile population using a standard international measure. Results confirm widespread and severe FI, highlighting a potential humanitarian crisis requiring both national and international attention. Further research is critical to inform strategies for guaranteeing the right to food access for migrants in transit through third (non-destination) countries.

Cross-Sectional Association of Food Source with Food Insecurity, Dietary Diversity and Body Mass Index in Western Kenya.

The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption (‘own livestock’) had lower odds of moderate or severe household food insecurity (odds ratio (OR) = 0.29 (95% CI: 0.09, 0.96)) and those that reported buying food from supermarkets had lower odds of moderate or severe household food insecurity (borderline significant, OR = 0.37 (95% CI: 0.14, 1.00)), increased dietary diversity scores (Poisson coefficient = 0.17 (95% CI: 0.10, 0.24)) and higher odds of achieving minimum dietary diversity (OR = 2.84 (95% CI: 1.79, 4.49)). Our findings provide insight into the relationship between food environments, dietary patterns and nutrition in Kenya, and suggest that interventions that influence household food source may impact the malnutrition burden in this context.

Translation and validation of Food Insecurity Experience Scale (FIES)

Introduction: Food insecurity has a complex and multifaceted concept and definition, thus assessing it has been an ongoing challenge for researchers, health practitioners, and policy makers. Previous studies reported inconsistent findings on the prevalence and severity of food insecurity, depending on the measuring tools used. To overcome this limitation, this study aimed to translate and validate the Food Insecurity Experience Scale (FIES) for Malaysians, which has been used as a standard measurement by Food and Agriculture Organization (FAO). Methods: Two forward and backward translations involving experts in food insecurity studies and experts in language were done, as well as the pre-test and cognitive interview stipulated in World Health Organization (WHO) translation guidelines. Content and face validity were conducted as part of the validation process. Content Validity Index (CVI) was done to analyse content validity. Results: The harmonised Malay version of FIES was produced with 1.0 CVI, which was above the 0.8 criteria. Face validity showed good understandability and clarity of FIES. Conclusion: The translated Malay version of FIES had good acceptability, as well as good face validity when tested among the target audience. Thus, a full validation study of the Malay version FIES should be done before it is widely used to measure food insecurity in the population, specifically the Malaysian population.

Newly Food-Insecure College Students in Appalachia During the COVID-19 Pandemic

ObjectiveThis study investigated if the coronavirus disease (COVID-19) pandemic influenced college student food insecurity and factors that might contribute to a student becoming newly food insecure. DesignA convenience sample was assessed using a cross-sectional survey. SettingOnline. ParticipantsCollege students (n = 2,018) enrolled at a land-grant institution in Appalachia. Main Outcome Measure(s)Food insecurity was assessed using the Hunger Vital Sign with reference before COVID-19 and since COVID-19. Demographic and pandemic-specific questions and their associations with food insecurity status were assessed. AnalysisStudents were categorized as food secure (food secure before and since COVID-19 or food insecure in the year before COVID-19 but not food insecure since COVID-19), consistently food insecure (food insecure before and since COVID-19), and newly food insecure (food secure before but food insecure since COVID-19). Multivariate logistic regression was used to investigate the relationship between new food insecurity and contributing factors. ResultsOf respondents, 68.4% were food secure, 16.5% were consistently food insecure, and 15.1% were newly food insecure. Loss of employment, increased grocery expenditure, anxiety, and a perceived threat posed by COVID-19 were significant indicators of students being newly food insecure. Conclusions and ImplicationsMore students were facing food insecurity as a result of the COVID-19 pandemic. Continued advocacy for sustainable solutions to college food insecurity is needed.

Food Insecurity Is Associated with Cognitive Function: A Systematic Review of Findings across the Life Course

Food insecurity (FI) has negative implications across the life course that include poor health outcomes among both children and adults. However, the behavioral mechanisms by which FI impacts health behaviors are not clear. By understanding how FI is related to cognitive function/brain structure across the life course, we can design more targeted interventions. A systematic literature review was performed by conducting comprehensive database searches in Google Scholar and PubMed. Inclusion criteria required studies to include measures of FI and cognitive function/brain structure in humans. Study sample, design, outcomes, and biases were extracted. In total, 17 studies met the inclusion criteria. Cognitive domains included general cognition (n = 13), executive function (n = 10), visuospatial abilities (n = 4), and verbal memory (n = 8). No studies examined brain structure. Most studies (88%) indicated significant inverse associations between FI and cognitive function across all stages of the life course, particularly for general cognition and executive function. Significant inverse associations were observed between FI and either general cognition or executive function among children (n = 3) and adults (n = 12). All studies considered confounding variables; however, given that all were observational, no causality can be inferred from the findings. These findings indicate that FI is related to lower cognitive function across the life course. Research should explore how changes in food security status impacts cognitive function and brain structure to develop optimal FI interventions and improve cognitive health.

Estimating the direct and indirect risks of becoming food insecure during the COVID-19 pandemic: a cross-sectional analysis using UK cohort data

BackgroundThe COVID-19 pandemic and associated UK containment measures implemented to reduce viral spread are likely to influence the prevalence of food insecurity. Food insecurity is associated with wide-ranging negative effects on health and wellbeing. Specific containment measures such as closure of schools and hospitality venues might be expected to disproportionately affect some vulnerable groups, including single parents and young people. We aimed to identify sociodemographic and economic factors that increase the likelihood of reporting food insecurity during the COVID-19 pandemic, and to explore the extent to which financial vulnerability and experiencing COVID-19 symptoms explain the likelihood of becoming food insecure. MethodsThis analysis used cross-sectional cohort data from April, July, and September, 2020, of the UK Understanding Society COVID-19 Survey, which involved approximately 17 000 households. Food insecurity was defined as reporting positively to either or both of: “being hungry and not able to eat” or “inability to access sufficient and nutritious food because of lack of money or other resources”. Logistic regression was used to identify sociodemographic and economic factors associated with increased risk of food insecurity during the COVID-19 pandemic. A decomposition approach was used to explore the extent to which these associations were explained by financial vulnerability, or experiencing COVID-19 symptoms. Ethics approval for the study was not required. FindingsSingle parents and young people aged 16–30 years were at highest risk of reporting either or both measures of food insecurity. For single parents, financial vulnerability explained 5–20% of the likelihood of being food insecure, and experiencing COVID-19 symptoms explained less than 5%. For young people, financial vulnerability explained 5–25% of the likelihood of being food insecure, and experiencing COVID-19 symptoms explained 5–30%. InterpretationSingle parents and young people may be especially at risk of food insecurity in the context of COVID-19. The wide explanatory ranges identified could be attributable to heterogeneity within groups and differing eligibility for financial support. Targeted funding, including for those self-isolating, could be an effective strategy to avoid or mitigate food insecurity among such vulnerable groups in the UK during the COVID-19 pandemic and other future pandemics. FundingNone.

Food Insecurity and International Migration Flows

The driving forces of international migration are increasingly complex and interrelated. This article examines the relationship between food insecurity and regular, permanent international migration. The analysis draws on data from the first global measure of individual-level food insecurity combined with data on migration flows from 198 origin countries to 16 Organization for Economic Co-operation and Development destination countries for 2014 and 2015. Using a fixed-effects regression model that resembles an augmented gravity equation controlling for various confounding factors, we show both a significant positive correlation between food insecurity at origin and out-migration and a positive correlation between out-migration and within-country inequality in food insecurity at origin. Our findings imply that people may react not only to the average prevalence of food insecurity but also to their relative position in the distribution of food insecurity within their origin country. This finding may help inform policymakers about potential threshold effects and guide the design of migration policies and aid programs. It also contributes to the study of international migration flows by presenting novel evidence for the role of food insecurity and within-country inequality in food insecurity as drivers of migration flows.

The Measurement of Food Insecurity in High-Income Countries: A Scoping Review.

The measurement of food insecurity is essential to monitor the prevalence, risk factors, consequences and effects of food insecurity and the interventions and policies implemented to tackle it. Yet, how best to apply it remains an unsettled issue due to the multifaceted and context-dependent nature of food insecurity. We report a scoping review of measures of food insecurity at the individual and household level in high-income countries with the final purpose of facilitating a catalogue of instruments to be used by both researchers and practitioners. The scoping review was conducted following the methodological framework of Arksey and O’Malley and the Joanna Briggs Institute guidelines. We included all types of documents published between 2000–2020 using instruments that estimate food insecurity at both individual and household level in high-income countries, and with respondents including adolescents, adults, and elderly. We identified a total of 23 measurement strategies being used in 33 peer-reviewed publications and 114 documents from the grey literature. Our results show that most measures focus on the access dimension of food insecurity and that further research is required to develop measures that incorporate aspects of quality of dietary intake and relevant individual, household and social conditions related to food insecurity.

Household food insecurity during pregnancy as a predictor of anthropometric indices failures in infants aged less than 6 months: a retrospective longitudinal study.

To investigate the impact of household food insecurity during the third trimester of pregnancy on the growth indicators of infants aged less than 6 months. Retrospective longitudinal study. 137 healthcare centres (15 cities) in Khorasan Razavi province, Iran. Data were extracted from the Sina Electronic Health Record System (SinaEHR®). This study was conducted on 2481 mother and infant dyads during November 2016-March 2019. The Household Food Insecurity Access Scale (nine-item version) was used to measure food insecurity in the third trimester of pregnancy. Women who delivered singleton infants were included in the study, and anthropometric indices of infants were measured throughout the first 6 months of life. Approximately 67 % of the participants were food secure, while 33 % had varying degrees of food insecurity. The children born to the mothers in the food-insecure households were, respectively, 2·01, 3·03, and 3·83 times more likely to be stunted at birth (95 % CI 1·17, 3·46), 4 months (95 % CI 1·21, 7·61) and 6 months of age (95 % CI 1·37, 10·68) compared to their counterparts in the food-secure households. However, there were no significant differences in mean birth weight, birth height and head circumference at birth between the two groups. Household food insecurity during pregnancy is a risk factor for stunting in infants aged less than 6 months. Therefore, national nutrition programs could considerably support women in food-insecure households during and before pregnancy.

Proxy longitudinal indicators of household food insecurity in the UK

Background: Rising food bank usage in the UK suggests a growing prevalence of food insecurity. However, a formalised, representative measure of food insecurity was not collected in the UK until 2019, over a decade after the initial proliferation of food bank demand. In the absence of a direct measure of food insecurity, this article identifies and summarises longitudinal proxy indicators of UK food insecurity to gain insight into the growth of insecure access to food in the 21st century. Methods: A rapid evidence synthesis of academic and grey literature (2005–present) identified candidate proxy longitudinal markers of food insecurity. These were assessed to gain insight into the prevalence of, or conditions associated with, food insecurity. Results: Food bank data clearly demonstrates increased food insecurity. However, this data reflects an unrepresentative, fractional proportion of the food insecure population without accounting for mild/moderate insecurity, or those in need not accessing provision. Economic indicators demonstrate that a period of poor overall UK growth since 2005 has disproportionately impacted the poorest households, likely increasing vulnerability and incidence of food insecurity. This vulnerability has been exacerbated by welfare reform for some households. The COVID-19 pandemic has dramatically intensified vulnerabilities and food insecurity. Diet-related health outcomes suggest a reduction in diet quantity/quality. The causes of diet-related disease are complex and diverse; however, evidence of socio-economic inequalities in their incidence suggests poverty, and by extension, food insecurity, as key determinants. Conclusion: Proxy measures of food insecurity suggest a significant increase since 2005, particularly for severe food insecurity. Proxy measures are inadequate to robustly assess the prevalence of food insecurity in the UK. Failure to collect standardised, representative data at the point at which food bank usage increased significantly impairs attempts to determine the full prevalence of food insecurity, understand the causes, and identify those most at risk.

Proxy longitudinal indicators of household food insecurity in the UK

Background: Rising food bank usage in the UK suggests a growing prevalence of food insecurity. However, a formalised, representative measure of food insecurity was not collected in the UK until 2019, over a decade after the initial proliferation of food bank demand. In the absence of a direct measure of food insecurity, this article identifies and summarises longitudinal proxy indicators of UK food insecurity to gain insight into the growth of insecure access to food in the 21st century. Methods: A rapid evidence synthesis of academic and grey literature (2005–present) identified candidate proxy longitudinal markers of food insecurity. These were assessed to gain insight into the prevalence of, or conditions associated with, food insecurity. Results: Food bank data clearly demonstrates increased food insecurity. However, this data reflects an unrepresentative, fractional proportion of the food insecure population without accounting for mild/moderate insecurity, or those in need not accessing provision. Economic indicators demonstrate that a period of poor overall UK growth since 2005 has disproportionately impacted the poorest households, likely increasing vulnerability and incidence of food insecurity. This vulnerability has been exacerbated by welfare reform for some households. The COVID-19 pandemic has dramatically intensified vulnerabilities and food insecurity. Diet-related health outcomes suggest a reduction in diet quantity/quality. The causes of diet-related disease are complex and diverse; however, evidence of socio-economic inequalities in their incidence suggests poverty, and by extension, food insecurity, as key determinants. Conclusion: Proxy measures of food insecurity suggest a significant increase since 2005, particularly for severe food insecurity. Proxy measures are inadequate to robustly assess the prevalence of food insecurity in the UK. Failure to collect standardised, representative data at the point at which food bank usage increased significantly impairs attempts to determine the full prevalence of food insecurity, understand the causes, and identify those most at risk.

Interventions to Address Food Insecurity Among Adults in Canada and the US

Inadequate access to food is a risk factor for poor health and the effectiveness of federal programs targeting food insecurity, such as the Supplemental Nutrition Assistance Program (SNAP), are well-documented. The associations between other types of interventions to provide adequate food access and food insecurity status, health outcomes, and health care utilization, however, are unclear. To review evidence on the association between food insecurity interventions and food insecurity status, clinically-relevant health outcomes, and health care utilization among adults, excluding SNAP. A systematic search for English-language literature was performed in PubMed Central and Cochrane Trials databases (inception to January 23, 2020), the Social Interventions Research and Evaluation Network database (December 10, 2019); and the gray literature using Google (February 1, 2021). Studies of any design that assessed the association between food insecurity interventions for adult participants and food insecurity status, health outcomes, and health care utilization were screened for inclusion. Studies of interventions that described addressing participants' food needs or reporting food insecurity as an outcome were included. Interventions were categorized as home-delivered food, food offered at a secondary site, monetary assistance in the form of subsidies or income supplements, food desert interventions, and miscellaneous. Data extraction was performed independently by 3 reviewers. Study quality was assessed using the Cochrane Risk of Bias Tool, the ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) tool, and a modified version of the National Institutes of Health's Quality Assessment Tool for Before-After Studies With No Control. The certainty of evidence was based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria and supplemented with mechanistic and parallel evidence. For outcomes within intervention categories with at least 3 studies, random effects meta-analysis was performed. Food insecurity (measured through surveys; eg, the 2-item Hunger Vital Sign), health outcomes (eg, hemoglobin A1c), and health care utilization (eg, hospitalizations, costs). A total of 39 studies comprising 170 605 participants were included (8 randomized clinical trials and 31 observational studies). Of these, 14 studies provided high-certainty evidence of an association between offering food and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.53; 95% CI, 0.33-0.67). Ten studies provided moderate-certainty evidence of an association between offering monetary assistance and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.64; 95% CI, 0.49-0.84). There were fewer studies of the associations between interventions and health outcomes or health care utilization, and the evidence in these areas was of low or very low certainty that any food insecurity interventions were associated with changes in either. This systematic review with meta-analysis found that providing food and monetary assistance was associated with improved food insecurity measures; however, whether it translated to better health outcomes or reduced health care utilization was unclear.

Family policy and food insecurity: an observational analysis in 142 countries

SummaryBackgroundLevels of child malnutrition and hunger across the world have decreased substantially over the past century, and this has had an important role in reducing mortality and improving health. However, progress has stalled. We examined whether family policies (eg, cash transfers from governments that aim to support households with children) are associated with reduced food insecurity.MethodsIn this observational analysis, we used a dataset of individual-level data that captured experience-based measures of food insecurity and sociodemographic characteristics collected by the Gallup World Poll in 142 countries for 2014–17. We then combined this dataset with indicators of the type and generosity of family policies in these countries, taken from the University of California, Los Angeles’ World Policy Analysis Center. We used multilevel regression models to examine the association between the presence of family policies for households with children and the probability of reporting moderate or severe food insecurity or severe food insecurity (moderate or severe food insecurity was defined as a “yes” response to at least four of eight questions on the Gallup Food Insecurity Experience Scale, and severe food insecurity was defined as a “yes” response to at least seven questions). We controlled for multiple covariates, including individual-level measures of social position and country-level measures, such as gross domestic product. We further examined whether this association varied by household income level.FindingsUsing data from 503 713 households, we found that, on average, moderate or severe food insecurity is 4·09 percentage points (95% CI 3·50–4·68) higher in households with at least one child younger than 15 years than in households with no children and severe food insecurity is 2·20 percentage points (1·76–2·63) higher. However, the additional risk of food insecurity among households with children is lower in countries that provide financial support (either means-tested or universal) for families than for countries with little or no financial assistance. These policies not only reduce food insecurity on average, but they also reduce inequalities in food insecurity by benefiting the poorest households most.InterpretationIn some countries, family policies have been cut back in the past decade and such retrenchment might expose low-income households to increased risk of food insecurity. By increasing investment in family policies, progress towards Sustainable Development Goal 2, zero hunger, might be accelerated and, in turn, improve health for all.FundingWellcome Trust.

Psychometric properties of a modified version of Brazilian household food insecurity measurement scale - Pró-Saúde study.

We present results of initial steps of the psychometric evaluation of a proposed modified version of the Brazilian Household Food Insecurity Measurement Scale aimed at assessing adults' recall of food insecurity at age 12. Data were obtained through self-administered questionnaires from civil servants at university campuses in Rio de Janeiro, who participated in the first and fourth waves of the longitudinal Pró-Saúde Study. We evaluated test-retest reliability (n=58), internal consistency, factor structure, convergent, discriminant validity (n=3,253). Test-retest reliability kappa coefficients were above 0.65; Cronbach's α coefficient was 0.84. Factor loadings were above 0.800. The composite reliability was above 0.90. The square root values of the Average Variance Extracted were positive and statistically significant. Household food insecurity during childhood was strongly associated with larger family size and several sociodemographic conditions at age 12: female head of household, residence in rural area or small town, worse standard of living, and insufficient food due to lack of money. This initial evaluation suggests good performance. Further investigation should include additional psychometric properties and other population contexts.

Insult to injury: National analysis of return to work and financial outcomes of trauma patients.

While much of trauma care is rightly focused on improving inpatient survival, the ultimate goal of recovery is to help patients return to their daily lives after injury. Although the overwhelming majority of trauma patients in the United States survive to hospital discharge, little is known nationally regarding the postdischarge economic burden of injuries among trauma survivors. We used the National Health Interview Survey from 2008 to 2017 to identify working-age trauma patients, aged 18 to 64 years, who sustained injuries requiring hospitalization. We used propensity score matching to identify noninjured respondents. Our primary outcome measure was postinjury return to work among trauma patients. Our secondary outcomes included measures of food insecurity, medical debt, accessibility and affordability of health care, and disability. A nationally weighted sample of 319,580 working-age trauma patients were identified. Of these patients, 51.7% were employed at the time of injury, and 58.9% of them had returned to work at the time of interview, at a median of 47 days postdischarge. Higher rates of returning to work were associated with shorter length of hospital stay, higher education level, and private health insurance. Injury was associated with food insecurity at an adjusted odds ratio (aOR) of 1.8 (95% confidence interval, 1.40-2.37), with difficulty affording health care at aOR of 1.6 (1.00-2.47), with medical debt at aOR of 2.6 (2.11-3.20), and with foregoing care due to cost at aOR of 2.0 (1.52-2.63). Working-age trauma patients had disability at an aOR of 17.6 (12.93-24.05). The postdischarge burden of injury among working-age US trauma survivors is profound-patients report significant limitations in employment, financial security, disability, and functional independence. A better understanding of the long-term impact of injury is necessary to design the interventions needed to optimize postinjury recovery so that trauma survivors can lead productive and fulfilling lives after injury. Economic & Value-Based Evaluations, level II; Prognostic, level II.