Reported Food Insecurity Research Articles

Association Between Women’s Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand

Intimate partner violence (IPV) is increasingly recognized as a contributing factor for long-term health problems; however, few studies have assessed these health outcomes using consistent and comprehensive IPV measures or representative population-based samples. To examine associations between women's lifetime IPV exposure and self-reported health outcomes. The cross-sectional, retrospective 2019 New Zealand Family Violence Study, adapted from the World Health Organization's Multi-Country Study on Violence Against Women, assessed data from 1431 ever-partnered women (63.7% of eligible women contacted) in New Zealand. The survey was conducted from March 2017 to March 2019, across 3 regions, which accounted for approximately 40% of the New Zealand population. Data analysis was performed from March to June 2022. Exposures were lifetime IPV by types (physical [severe/any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types. Outcome measures were poor general health, recent pain or discomfort, recent pain medication use, frequent pain medication use, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition. Weighted proportions were used to describe the prevalence of IPV by sociodemographic characteristics; bivariate and multivariable logistic regressions were used for the odds of experiencing health outcomes by IPV exposure. The sample comprised 1431 ever-partnered women (mean [SD] age, 52.2 [17.1] years). The sample was closely comparable with New Zealand's ethnic and area deprivation composition, although younger women were slightly underrepresented. More than half of the women (54.7%) reported any lifetime IPV exposure, of whom 58.8% experienced 2 or more IPV types. Compared with all other sociodemographic subgroups, women who reported food insecurity had the highest IPV prevalence for any IPV (69.9%) and all specific types. Exposure to any IPV and specific IPV types was significantly associated with increased likelihood of reporting adverse health outcomes. Compared with those unexposed to IPV, women who experienced any IPV were more likely to report poor general health (adjusted odds ratio [AOR], 2.02; 95% CI, 1.46-2.78), recent pain or discomfort (AOR, 1.81; 95% CI, 1.34-2.46), recent health care consultation (AOR, 1.29; 95% CI, 1.01-1.65), any diagnosed physical health condition (AOR, 1.49; 95% CI, 1.13-1.96), and any mental health condition (AOR, 2.78; 95% CI, 2.05-3.77). Findings suggested a cumulative or dose-response association because women who experienced multiple IPV types were more likely to report poorer health outcomes. In this cross-sectional study of women in New Zealand, IPV exposure was prevalent and associated with an increased likelihood of experiencing adverse health. Health care systems need to be mobilized to address IPV as a priority health issue.

Service, Scholarship, and Sacrifice: A Qualitative Analysis of Food Security Barriers and Strategies among Military-Connected Students.

In the United States, 41% of 4-year university student veterans have reported food insecurity, but literature on food insecurity among military-connected students is limited. The objective of the study was to increase knowledge of military-connected student food insecurity experiences and potential strategies to address food access. The study is a cross-sectional survey and nonexperimental qualitative cohort analysis. Military-connected students (n= 127) responded to a survey sampling all enrolled students at a Mountain West land grant university during spring 2020. Military-connected student focus group participants (n= 8) were purposively sampled from the same university during fall2020. Main outcome measures were demographic data and food insecurity rates. Qualitative measures included responses to questions about food insecurity among military-connected students, actions for improving food insecurity, and insight into food access resources on campus. Descriptive statistics were used to determine food insecurity rates. Qualitative analysis included audio recording and transcription, then a step-by-step process for coding and theme development. Food insecurity was reported by 42.5% of military-connected student survey respondents. Qualitative analysis revealed themes about current and planned food access resources, barriers to food security, and strategies to promote military-connected student food security. Main themes related to resources were access to resources and food offerings. Main barrier themes were pride and shame. Main strategy themes included military pride and military connections and culture. Military-connected students are at least as vulnerable to food insecurity as the student body at large. Qualitative analysis identified barriers and strategies for food security among military-connected students. Feelings of pride in identifying with the military seemed to amplify feelings of shame about food insecurity; however, this pride and sense of military community also suggest that food security efforts specifically tailored to military-connected students could be successful.

Food Security in the Time of COVID-19 for a Marshallese Community

Using an individual and family ecological systems model, we explored food security among a Marshallese cohort in Northwest Arkansas during the COVID-19 pandemic. We hypothesized that Marshallese households were experiencing high rates of food insecurity due to socioeconomic and systemic risk factors. Seventy-one Marshallese adults shared socioeconomic information about their household via an online survey. Descriptive results indicate that 91% of respondents report food insecurity. In terms of systemic barriers, almost half of Marshallese respondents do not have health insurance. Additionally, while most respondents report feeling calm, peaceful, and energetic, paradoxically, 81% report feeling depressed and downhearted at least some of the time. Logistic regression findings suggest that food insecurity is significantly related to education levels and household economic strain. These results are analogous with national findings, whereby non-native households are more likely to experience higher levels of food insecurity, lower rates of education, and higher economic strain than native households. As a collective community, the Marshallese could benefit from culturally responsive individual and family systems approaches for improving educational, social, financial, and health opportunities through workforce development, household income and asset development, and food security initiatives. Additional implications for policy, practice, and research are provided.

Prevalence and Determinants of Unmet Social Needs Among Rural and Urban Veterans.

To examine the prevalence and determinants of nine unmet social needs among rural compared with urban Veterans. Retrospective study using survey data collected in 2020 merged with Veterans Health Administration (VA) administrative data. For each unmet need, separate logistic regression modes were run predicting the odds of rural compared with urban Veterans endorsing the need adjusting for sociodemographic characteristics and comorbidities. 2,801 Veterans responded to the survey (53.7% response rate). Veterans experienced high rates of need (e.g., 22% reported food insecurity). Unmet need prevalence varied minimally between rural and urban Veterans and where they did, rural Veterans were less likely to endorse the need (e.g., loneliness). For many unmet needs, Black compared with White Veterans were at higher risk. Regional unmet need disparities were also observed. As VA considers expanding unmet need interventions, tailoring interventions to the sub-populations most at risk may be warranted.

Abstract WP195: Dietary Fat Intake, Food Insecurity, And Anxiety Among Stroke Survivors

Introduction: During recovery, stroke patients are at risk of developing psychological complications impacting their quality of life. Diets rich in fat negatively impact anxiety disorders; however, this relationship has not been explored among stroke survivors considering food insecurity status, a social determinant of health (SDOH). Methods: In a population-based cohort of 309 patients with acute stroke, we retrospectively assessed self-administered surveys to evaluate the association between dietary fat intake and anxiety in stroke survivors presenting for an initial visit at a University-based stroke clinic from January 2021-July 2021 in Houston, Texas. Anxiety was measured using the GAD-7 scoring system and dichotomized to either “None/Mild” or “Moderate/Severe.” Dietary fat intake was calculated using the quality frequency screener; food insecurity status, using the Hunger Vital sign screener. Results: Among this population, 15.46% reported food insecurity and 50.8% (N=157) had moderate to severe anxiety. The multivariable logistic regression model showed that total fat intake (Odds Ratio (OR)=1.01, 95% CI: 1.00, 1.03; P-value=0.016) and percent fat (OR=1.06, 95% CI: 1.01, 1.11; P-value=0.018) dietary intake had a statistically significant negative impact on anxiety, adjusting for covariates and an interaction term between food insecurity status and dietary fat intake. Conclusion: Although studies describe the role of a healthy diet in stroke, this is the first study that looks at dietary fat intake as it relates to stroke and anxiety, as well as, food insecurity among stroke survivors. SDOH including food access and affordability are associated with stroke risk and dietary fat outcomes. A better understanding of fat intake and associated factors in this population will provide an opportunity for developing interventions for those at highest risk. Access to healthy foods may prevent higher intake of fat in one’s diet and reduce the risk of stroke.

Impact of COVID-19 on Infants followed after Discharge from the Neonatal Intensive Care Unit Using a Telemedicine Model.

Coronavirus disease 2019 (COVID-19) continues to have a profound impact on infant health care and health outcomes. In this study, we aimed to characterize the social impact of the first COVID-19 lockdown on families in a neonatal follow-up program (NFP). Given the ongoing increased use of telehealth across the medicine, we also evaluated for patient-level differences in virtual visit rates to identify patients at risk of follow-up challenges. To assess the impact of virtual health care utilization, we conducted a retrospective cohort study to describe challenges associated with telemedicine use in this vulnerable patient population during our telemedicine epoch (March 13, 2020-July 31, 2020). We also looked for patient-level factors associated with attending NFP visits as scheduled. Finally, we summarized caregiver responses to a COVID-19 Obstacles Assessment Survey and assessed for racial disparities in these responses. When comparing patients who completed their virtual visit to those who did not, we found no differences by infants' sex, birth weight, gestational age at birth, or caregiver self-reported race and ethnicity. However, infants whose visits did not occur were more often discharged with equipment or covered by public insurance. Nine percent of families reported food insecurity. During the initial COVID-19 lockdown, families with infants discharged from a neonatal intensive care unit (NICU) faced significant obstacles caring for their infants and attending scheduled follow-up visits. Infants in families with lower socioeconomic status or with increased medical complexity faced increased challenges in attending virtual follow-up visits during this epoch. Given the ongoing reliance on telemedicine in health care and the need to better prepare for future epidemics/pandemics, this study offers critical information that can assist neonatal teams in bolstering transitions to home and creating stronger safety nets for their patients after discharge. · Telemedicine works well for high-risk neonatal populations.. · Infant medical complexity may be a risk factor for challenges attending neonatal follow-up visits.. · NICUs should work to prevent food insecurity postdischarge..

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.

Abstract B097: Differences in health-related social needs between younger and older cancer survivors in a United States representative sample, 2016-2018

Abstract Background: Health-Related Social Needs (HRSN) are unmet person-level social and economic challenges, such as food and housing insecurity, that potentially impact health outcomes. Evidence of HRSN burden in cancer survivors is limited and differences across age groups largely unexplored. Our goal is to estimate the prevalence of HRSN among cancer survivors across age groups and explore associated factors in a nationally representative sample. Methods: A cross-sectional cohort of cancer survivors, 18 years and older, was identified from the National Health Interview Survey (NHIS), 2016-2018. Survivorship (i.e., time since cancer diagnosis) was assessed at the time of the survey. Key needs for cancer survivors (food insecurity, transportation needs, inability to pay for utilities, inability to pay for housing, and inability to pay for healthcare needs) were used in this analysis. Individuals report their current experience with needs at the time of the survey. Prevalence rates were estimated as the proportion of cancer survivors with a given need within each of the five key needs. A measure of HRSN was developed to indicate whether an individual experienced at least one or more HRSN (any HRSN). Multivariable logistic regression was used to explore the association between having any HRSN and current age (young [YA], 18-39y; middle age [MA], 40-64y; older adult [OA], &amp;gt;=65 y), key sociodemographic characteristics, age at cancer diagnosis, and survivorship. All estimates, including Odds Ratios (OR) and 95% confidence intervals (CI), were weighted to represent the US census-based population. Results: We identified 7,179 cancer survivors, 44.9% under 65 years old, 59.1% female, 85.9% White. Overall, 44.8% reported experiencing any HRSN at any time during survivorship, with 21.4% experiencing any HRSN in their first two years after cancer diagnosis. Inability to pay for utilities was the most prevalent need, with differences across age groups (40.7% YA, 33.4% MA, 17.2% OA). Higher inability to pay for housing was reported among YA (28.64%) than MA (25.9%) or OA (11.9%). There were no differences in reported food insecurity across age groups (YA 16.2%, MA 16.5%, OA 16.5%). When compared to OA, YA (OR 1.77, CI 1.24-2.60) and MA (OR 1.74, CI 1.49-2.01) had higher odds of having any HRSN. Key factors associated with higher odds of any HRSN include being non-White (OR 1.42, CI 1.16-1.74), Hispanic (OR 1.46, CI 1.08-1.98), female (OR 1.31, CI 1.14-1.51), or being diagnosed with cancer during childhood (OR 1.62, CI 1.04-2.52) or young adulthood (OR 1.65, CI 1.29-2.23). Conclusion: HRSN are prevalent throughout cancer survivorship. Our findings show that young and middle age are more likely than older adults to experience HRSN at any point during survivorship. Further exploration of pathways leading to unmet needs is needed to address inequalities and improve survivorship care across age groups. Citation Format: Wendy Camelo Castillo, Udim Damachi, Phuong Tran, Christabel K. Cheung, Ester Villalonga-Olives, Eberechukwu Onukwugha. Differences in health-related social needs between younger and older cancer survivors in a United States representative sample, 2016-2018 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B097.

The prevalence and socio-demographic associations of household food insecurity in seven slum sites across Nigeria, Kenya, Pakistan, and Bangladesh. A cross-sectional study.

Although the proportion of people living in slums is increasing in low- and middle-income countries and food insecurity is considered a severe hazard for health, there is little research on this topic. This study investigated and compared the prevalence and socio-demographic associations of household food insecurity in seven slum settings across Nigeria, Kenya, Pakistan, and Bangladesh. Data were taken from a cross-sectional, household-based, spatially referenced survey conducted between December 2018 and June 2020. Household characteristics and the extent and distribution of food insecurity across sites was established using descriptive statistics. Multivariable logistic regression of data in a pooled model including all slums (adjusting for slum site) and site-specific analyses were conducted. In total, a sample of 6,111 households were included. Forty-one per cent (2,671) of all households reported food insecurity, with varying levels between the different slums (9-69%). Household head working status and national wealth quintiles were consistently found to be associated with household food security in the pooled analysis (OR: 0·82; CI: 0·69-0·98 & OR: 0·65; CI: 0·57-0·75) and in the individual sites. Households which owned agricultural land (OR: 0·80; CI: 0·69-0·94) were less likely to report food insecurity. The association of the household head's migration status with food insecurity varied considerably between sites. We found a high prevalence of household food insecurity which varied across slum sites and household characteristics. Food security in slum settings needs context-specific interventions and further causal clarification.

Food Insufficiency, Supplemental Nutrition Assistance Program (SNAP) Status, and 9-Year Trajectory of Cognitive Function in Older Adults: The Longitudinal National Health and Aging Trends Study, 2012–2020

BackgroundDespite findings from cross-sectional studies, how food insecurity experience/Supplemental Nutrition Assistance Program (SNAP) status relates to cognitive decline over time has not been fully understood. ObjectivesWe aimed to investigate the longitudinal associations between food insecurity/SNAP status and cognitive function in older adults (≥65 y). MethodsLongitudinal data from the National Health and Aging Trends Study 2012–2020 were analyzed (n = 4578, median follow-up years = 5 y). Participants reported food insecurity experience (5-item) and were classified as food sufficient (FS, no affirmative answer) and food insufficient (FI, any affirmative answer). The SNAP status was defined as SNAP participants, SNAP eligible nonparticipants (≤200% Federal Poverty Line, FPL), and SNAP ineligible nonparticipants (>200% FPL). Cognitive function was measured via validated tests in 3 domains, and the standardized domain-specific and combined cognitive function z-scores were calculated. Mixed-effect models with a random intercept were used to study how FI or SNAP status was associated with combined and domain-specific cognitive z-scores over time, adjusting for static and time-varying covariates. ResultsAt baseline, 96.3% of the participants were FS and 3.7% were FI. In a subsample (n = 2832), 10.8% were SNAP participants, 30.7% were SNAP eligible nonparticipants, and 58.6% were SNAP ineligible nonparticipants. Compared with the FS group in the adjusted model (FI vs. FS), FI was associated with faster decline in the combined cognitive function scores [−0.043 (−0.055, −0.032) vs. −0.033 (−0.035, −0.031) z-scores per year, P-interaction = 0.064]. Cognitive decline rates (z-scores per year) in the combined score were similar in SNAP participants (β = −0.030; 95% CI: −0.038, −0.022) and SNAP ineligible nonparticipants (β = −0.028; 95% CI: −0.032, −0.024), both of which were slower than the rate in SNAP eligible nonparticipants (β = −0.043; 95% CI: −0.048, −0.038; P-interaction < 0.0001). ConclusionsFood sufficiency and SNAP participation may be protective factors preventing accelerated cognitive decline in older adults.

Factors associated with motherhood among urban refugee adolescent girls and young women in informal settlements in Kampala, Uganda

ABSTRACT Adolescent girls and young women (AGYW) in sub-Saharan Africa face a high risk of unintended pregnancy. This risk is compounded in informal settlements, where resources are scarce and access to sexual and reproductive health services is limited. Being a young mother in informal settlements could exacerbate existing experiences of resource scarcity and poor access to sexual and reproductive health services. To explore this, we analyzed the factors associated with motherhood among refugee AGYW in Kampala, Uganda. Between January and March 2018, peer researchers recruited refugee youth aged 15–24 and living in five informal settlements in Kampala to participate in this study. We used a backwards generalized linear model with a log binomial regression to determine if mental health, resource insecurity and sexual and reproductive health variables were associated with motherhood among study participants. Our analysis included 333 AGYW with a mean age of 19.3 years (standard deviation: 2.6). Nearly one-quarter (23 percent; n = 76) of AGYW had children. Having children was associated with greater likelihood of reporting food insecurity (adjusted prevalence ratio [aPR]: 1.96, 95 percent confidence interval [CI]: 1.07–3.61), depressive symptoms (aPR: 2.03, 95 percent CI: 1.09–3.80), and contraception uptake (aPR: 2.37, 95 percent CI: 1.58–3.56) compared to not having children. Mental health and resource insecurity interventions are required for refugee AGYW with children in informal settlements. Sexual and reproductive health services should be promoted to refugee AGYW regardless of motherhood status to prevent unplanned pregnancy.

Relationship between food insecurity and housing instability on quality of care and quality of life in adults with diabetes.

Examine the relationship between food and housing insecurities, quality of care and quality of life in adults with diabetes using a nationally representative data source. Data from 39,604 adults with diabetes who indicated if they experienced food and/or housing insecurity in the Behavioral Risk Factor Surveillance System (2014, 2015, 2017) was analyzed. Outcomes included quality of care (HbA1c test, eye exam, diabetes education, foot check) and quality of life (general health status, poor physical and mental health days, poor overall health days). Logistic models were run for each quality of care measure and linear models were run for each quality of life measure adjusting for socio-demographics, insurance status, and comorbidity count. 35.6% of adults with diabetes reported housing insecurity, 31.8% reported food insecurity, and 23.4% reported both. After adjustment, food and housing insecurity was significantly associated with lower odds of having an eye exam (housing:0.73, 95%CI:0.63,0.85; food:0.78, 95%CI:0.67,0.92; both:0.69, 95%CI:0.59,0.82), worse general health status (housing:-0.06 95%CI:-0.11,-0.01; food:-0.16, 95%CI:-0.21,-0.10; both:-0.14, 95%CI:-0.20,-0.09), and an increased number of poor mental health days (housing:1.73, 95%CI:0.83,2.63; food:2.08, 95%CI:1.16,3.00; both:1.97, 95%CI:1.05,2.90). Food insecurity was also associated with lower odds of receiving diabetes education (0.86, 95%CI:0.74,0.99) and an increased number of poor physical health days (0.95, 95%CI:0.14,1.76). Changes to our healthcare delivery system are critical to improving standards of care and quality of life in all populations and may require a shift towards consideration of overlapping social risk factors rather than the siloed approach currently used.

Medically tailored meals for food insecurity and type 2 diabetes: Protocol for the Food as Medicine for Diabetes (FAME-D) trial

BackgroundFood insecurity is associated with worse glycemic management for individuals with type 2 diabetes mellitus (T2DM), but whether medically tailored meals (MTM), a food insecurity intervention, can improve glycemic management is unclear. ObjectiveTo describe the protocol for a trial assessing whether an MTM plus lifestyle intervention improves hemoglobin A1c (HbA1c) and participant-reported outcomes, relative to a food subsidy (money that can be spent on foods participants choose), for adults with both T2DM and food insecurity. MethodsThe Food as Medicine for Diabetes (FAME-D) randomized clinical trial (goal n = 200) is a pragmatic trial with an active comparator. Participants, who will have T2DM and report food insecurity, will be randomly assigned to a 6-month MTM plus telephone-delivered lifestyle change intervention, or a 6-month food subsidy ($40/month). The primary outcome is HbA1c at 6 months. Secondary outcomes include HbA1c at 12 months to assess whether the intervention effect (if any) is sustained, along with weight, food insecurity, diabetes distress, and health-related quality of life. Qualitative analyses of semi-structured interviews will help understand why, how, and under what circumstances the intervention achieved its observed results. ConclusionResults from FAME-D will help inform clinical management of food insecurity when it co-occurs with T2DM. Further, results may be useful as healthcare payors are considering coverage for MTM interventions.ClinicalTrials.gov: NCT04828785

The Psychosocial Needs of Patients Participating in Diabetes Shared Medical Appointments.

Patient reported outcomes (PROs) for diabetes are self-reported and often give insight into outcomes important to people with diabetes. Federally Qualified Health Centers (FQHCs) see patients who may have higher levels of diabetes distress and lower levels of self-care behaviors. The Invested in Diabetes study is a comparative effectiveness trial of diabetes Shared Medical Appointments (SMAs) in FQHCs and non-FQHC settings. PROs measure outcomes including validated measures on diabetes distress. 616 people from 22 practices completed PROs prior to SMAs. At FQHCs, participants were younger (average 57.7 years vs 66.9 years, p < 0.0001), more likely to be female (36.8% vs 46.1%, p = 0.02), and fewer spoke English (72.7% vs 99.6%, p < 0.0001). At FQHCs, diabetes distress was higher (2.1 vs 1.8, P = .02), more people were current smokers (14.3% vs 4.7%, P = .0002), on insulin (48.9% vs 22.3%, P < .0001) and reported food insecurity (52.7% vs 26.2%, P < .0001). After controlling for sociodemographic factors, these differences were nonsignificant. Higher numbers of patients at FQHCs report diabetes distress and food insecurity compared with patients in non-FQHC settings, indicating that patient social circumstances need to be considered as part of program implementation.

Exploring association between food insecurity and depression among older adults in India.

Depression is a significant health concern that is yet to be recognised as an important public health challenge in India. Furthermore, given the critical condition of food insecurity among older people in India, it is likely that they are more vulnerable to depression. The interplay of depression among older people resulting from food insecurity is an under-explored phenomenon in the Indian context. Therefore, this study examines the association between food insecurity and depression among older people in India. The study used data from the Longitudinal Ageing Study in India (LASI). Food insecurity was measured with a set of questions formed into dichotomous variable and depression was measured with Center for Epidemiological Studies Depression (CES-D scale). Binary logistic regression was performed to confirm the findings. Results showed that older adults who reported food insecurity were more likely to be depressed (OR= 1.20; C.I.=1.03-1.25) than their younger counterparts. Furthermore, older adults who were independent for Activity of Daily Living (ADL) were less likely (OR= 0.73; C.I.=0.53-1.00) to report depression, whereas, female (OR= 1.12; C.I.=1.00-1.26) and never married (OR= 2.11; C.I.=1.18-3.79) older adults were more likely to be depressed than their respective counterparts. It is important to integrate mental health with food insecurity. Future studies may consider including mental health services with food assistance programs or vice versa.

Social Risk Screening and Interventions in Healthcare Settings: Opportunities, Challenges, and Future Research.

Food insecurity, the insufficient or uncertain access to enough food, affected 14.8% of US households with children in 2020 and is associated with adverse physical, mental, and behavioral health across the lifecourse. 1 Coleman-Jensen A Rabbit MP Gregory CA et al. Household Food Insecurity in the United States in 2020, ERR-298. U.S. Department of Agriculture Economic Research Service, 2021 Google Scholar National healthcare organizations have recommended that clinicians screen patients for food insecurity and other social risk factors (Figure). In our study, “Written Versus Verbal Food Insecurity Screening in One Primary Care Clinic,” we evaluated a natural experiment that occurred at one clinic that converted from clinicians verbally asking a 2-item food insecurity questionnaire to parents/caregivers responding on a written form. 2 Palakshappa D Goodpasture M Albertini L et al. Written versus verbal food insecurity screening in one primary care clinic. Acad Pediatr. 2020; 20: 203-207https://doi.org/10.1016/j.acap.2019.10.001 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar We found that changing from a verbal to written screen resulted in an immediate and significant increase in the proportion of families who reported food insecurity (10.4% vs 16.3%). 2 Palakshappa D Goodpasture M Albertini L et al. Written versus verbal food insecurity screening in one primary care clinic. Acad Pediatr. 2020; 20: 203-207https://doi.org/10.1016/j.acap.2019.10.001 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar In this progress report, we consider our results in light of the published literature since we submitted our manuscript in May 2019 and discuss the increased focus on social inequities, growing investment in integrating social care, areas for future research, and potential challenges with social risk screening.

Understanding Dynamics of Food Insecurity and Vulnerability in Chepang Community

Chepangs are one of the highly marginalized indigenous peoples of Nepal who are vulnerable in terms of food security and have been living in environments characterized by high risk of various shocks. This study examines the dynamics of food insecurity and vulnerability in Chepang community. The study uses a mixed method approach. Data were obtained by using semi structured household questionnaire and key informant interview checklist. The household questionnaire included modules on household demographics, migration, housing facilities, assets and access to credit facilities, agriculture, income, expenditure, food sources and consumption patterns, shocks and food security. The questionnaire also contained questions on maternal and child health and nutrition. For child anthropometry, height and weight were also measured of all children below 5 years (6-59 months). About 90 percent of the sampled households reported food insecurity. Overall, assets deprivation, recurrent phenomena of covariate and idiosyncratic shocks, unfavorable state policies, and socio-cultural factors, low profile of education, larger family size, lack of income, higher expenditure on foods, low consumption patterns, and poor access to health care, water and sanitation facilities etc. are the major determinants of vulnerability of households to food insecurity. These factors were, in turn, determined by the poor resource endowment of the household which they could pursue in meeting their income and food security objectives. 75 percent of expenditure of Chepang households goes to food purchase. This high food expenditure share means that resources and incomes available to the households devotes to food indicating poor access to food. Again, more than 53 percent of the households belongs to the very poor and poor food consumption groups. This means suffering from food energy deficiencies, low dietary diversity, deriving more energy from staples, lacking micronutrients and having very poor and poor consumption patterns and poor food security status. The main coping strategies being adopted include unskilled wage laboring, collection, consumption and marketing of forest foods and products, sales of livestock animals, borrowing money and changing consumption patterns in the study area. This ethnicity based analysis could be of great value to the government, non-governmental organizations and development agencies in the design of effective food security strategies and development programs as policy response both now and in the future.

Relationship Between Food Security Status in a Caregiver's Family of Origin and Current Feeding Practices Among Low-Income, Single, Female Primary Caregivers.

A child's familial environment is paramount to the formation and maintenance of their health behaviors. Factors that influence a child's health behaviors include parental modeling, types of available food, timing of food availability, and characteristics of the home environment. Previous research has demonstrated an association between a caregiver's current food security status and feeding practices, but no studies have explored the association between food security in the caregiver's childhood and their current feeding practices. This study investigates the relationship between parental food insecurity (both current and childhood) and child feeding practices. The US Household Food Security Survey and the Child Feeding Questionnaire were completed by 103 low-income, single, female primary caregivers. Results indicated that caregivers who reported current food insecurity expressed greater tendency to pressure their children to eat. Caregivers who reported food insecurity during their childhood also expressed greater tendency to pressure their children to eat and a greater concern about their child's weight. These findings can serve in both research and clinical efforts as an early screening tool to indicate families most in need of accessible resources. Findings also help to highlight the transgenerational nature of food insecurity, including its residual effects on health behaviors.

Food Insecurity Among Individuals With Cardiovascular Disease and Cardiometabolic Risk Factors Across Race and Ethnicity in 1999-2018

Food insecurity is a risk factor for poor cardiovascular outcomes that occur disproportionately among individuals from racial and ethnic minority backgrounds who have cardiovascular disease (CVD) or cardiometabolic risk factors. To assess long-term prevalence of food insecurity among those with CVD or cardiometabolic risk factors in the United States. This serial cross-sectional study includes data for noninstitutionalized US adults from the National Health and Nutrition Examination Survey (1999-2018). Food insecurity was assessed using the US Department of Agriculture Adult Food Security Survey Module. We estimated prevalence of food insecurity among adults with prior CVD (myocardial infarction, stroke, heart failure) and cardiometabolic risk factors (hypertension, diabetes, obesity, hyperlipidemia) across racial and ethnic groups and prevalence of Supplemental Nutrition Assistance Program (SNAP) participation among those reporting food insecurity. In the analytic sample of 57 517 adults, 6770 individuals (11.8%) reported food insecurity, which was more prevalent among Hispanic (1938 [24.0%]) and non-Hispanic Black (1202 [18.2%]) than non-Hispanic Asian (100 [8.0%]) and non-Hispanic White adults (3221 [8.5%]). Among 57 517 adults, 4527 (7.9%) had any CVD, 2933 (5.1%) coronary artery disease, 1536 (2.7%) stroke, 1363 (2.4%) heart failure, 28 528 (49.6%) hypertension, 17 979 (33.2%) obesity, 6418 (11.2%) diabetes, and 19 178 (30.8%) dyslipidemia. All CVD and cardiometabolic diseases except coronary artery disease were more prevalent among those with food insecurity. Food insecurity increased over time and was more frequent for patients with CVD but not for cardiometabolic risk factors. From 2011 to 2018, non-Hispanic Black adults with CVD had a decrease in food insecurity prevalence (36.6%; 95% CI, 23.9%-49.4%, to 25.4%; 95% CI, 21.4%-29.3%; P = .04 for trend), whereas adults of other races and ethnicities or data based on cardiometabolic risk factors had no significant change. For individuals who had food insecurity, SNAP participation was higher among those with CVD vs without CVD (54.2%; 95% CI, 46.6%-61.8%, vs 44.3%; 95% CI, 40.5%-48.1%; P = .01). The prevalence of food insecurity among patients with CVD increased over time. Although members of non-Hispanic Black and Hispanic groups had the highest food insecurity, non-Hispanic Black individuals with CVD were the only group to have a significant decrease in food insecurity since 2011. Increased recognition of food insecurity and resources for treating it are needed to address the negative consequences of food insecurity on CVD outcomes.

Food security and feeding behaviours in low-income, Latinx families with preschool-aged children.

To examine the association between food security and feeding practices in Latinx parents of pre-school-aged children and examine possible effect modification by parental self-efficacy. Cross-sectional assessment using the US Department of Agriculture screener for food insecurity as the exposure and sub-scales of the Comprehensive Feeding Practices Questionnaire as the outcome with the General Self-Efficacy Scale as an effect modifier. Non-parametric descriptive statistics were used to compare groups based on food security status. Two Latinx communities with low-socioeconomic status in Texas in 2017 and in Oregon in 2018-2019. Latinx parents of preschool aged children, English and Spanish speaking. Dyads were excluded if they had moderate-severe developmental disabilities, a seizure disorder with a restrictive diet or taking medications known to influence typical growth. Of the 168 families in Oregon, 65 (38 %) reported food insecurity, and 10 (21 %) of the 48 families in Texas reported food insecurity. Food security was associated with greater parental monitoring practices in both the Texas and Oregon samples. We observed no differences in creating a healthy home food environment by food security status in either sample. Parental general self-efficacy showed evidence of effect modification in Oregon - only parents with lower self-efficacy showed a significant association between food security and feeding practices. Latinx parents of preschool children experience high levels of food insecurity, which are associated with maladaptive parental feeding practices. Greater parental general self-efficacy moderates this association and could buffer the effects of food insecurity on children's health.