Reported Food Insecurity Research Articles

Nutritional Concerns among Female International Volunteers Based on the Income and Development Status of Their Country of Service.

This study aimed to determine the prevalence of female athlete triad risk factors among female international volunteers based on the development and income status of their country of service. A total of 2164 past volunteers completed a retrospective survey. Countries’ income and development statuses were coded using the respective annual United Nations World Economic Situations and Prospects reports. Independent t-tests, ANOVAs, and Pearson’s Chi-Squared tests were used to assess group differences; corresponding odds ratios were calculated. Volunteers in nondeveloped (OR = 2.25, CI = 1.85–2.75) and non-high-income (OR = 2.17, CI = 1.75–2.70) countries had over twice the odds of experiencing secondary amenorrhea. More volunteers who served in nondeveloped countries reported an increase in exercise while serving (p = 0.005). Those who served in a nondeveloped (OR = 1.52, CI = 1.16–1.98) or non-high-income (OR = 1.45, CI = 1.08–1.94) country had higher odds of weight loss. However, volunteers serving in nondeveloped (OR = 0.52, CI = 0.44–0.63) and non-high-income (OR = 0.50, CI = 0.4–0.61) countries were less likely to report food insecurity compared to those in developed and high-income countries. Bone mineral density was within the expected range regardless of income and development status. Female volunteers who served in nondeveloped and non-high-income countries experienced higher odds of secondary amenorrhea, which was likely influenced by an increase in exercise and higher odds of weight loss.

Poverty and food insecurity during COVID-19: Phone-survey evidence from rural and urban Myanmar in 2020

Myanmar first experienced the COVID-19 crisis as a relatively brief economic shock in early 2020, before the economy was later engulfed by a prolonged surge in COVID-19 cases from September 2020 onwards. To analyze poverty and food security in Myanmar during 2020 we surveyed over 2000 households per month from June–December in urban Yangon and the rural dry zone. By June, households had suffered dramatic increases in poverty, but even steeper increases accompanied the rise in COVID-19 cases from September onwards. Increases in poverty were much larger in urban areas, although poverty was always more prevalent in the rural sample. However, urban households were twice as likely to report food insecurity experiences, suggesting rural populations felt less food insecure throughout the crisis.

Association between e-cigarette use and food insecurity among low-income adults

IntroductionPrevious research quantifying the relationship between tobacco use and food insecurity has focused on cigarette smoking. E-cigarette use has become popular in recent years. Drawing on large, population-based survey data,...

Health Literacy, Numeracy, and Dietary Approaches to Stop Hypertension Accordance Among Hypertensive Adults.

Health literacy (HL) and health numeracy (HN), the ability to interpret and act on quantitative health information, are important for hypertension self-management such as limiting sodium intake. We examined associations of HL, HN, and Dietary Approaches to Stop Hypertension (DASH) diet accordance. Among 1,073 hypertensive adults enrolled in a Baltimore, Maryland-based cohort study, we performed a cross-sectional analysis. Rapid Estimate of Adult Literacy in Medicine (REALM) measured HL and Test of Functional Health Literacy in Adults (TOFHLA) numeracy score measured HN. DASH accordance was based on nine key nutrients. Linear regression models estimated associations of HL and HN with DASH total and sodium score, inclusive of dietary supplement data. In our sample, 39% of participants were male, 66% were Black, 40.2% lived in poverty, and 29.5% reported food insecurity. Fully, 32.5% had limited HL and 14.5% had limited HN. Mean DASH score overall was 2 (range = 0-7.5); only 6.9% were DASH accordant (score ≥4.5). In age and sex adjusted models, higher REALM was associated with a higher DASH score in the overall sample; the relationship of HN with DASH was statistically significant among White but not Black participants. Educational attainment appeared to explain both findings. There were no significant associations between HL or HN and DASH sodium scores. Differences in educational attainment explained the relation of higher HL and greater accordance to the DASH diet in a population of hypertensive adults. Understanding these factors is vital to reducing disparities in hypertension and its sequelae.

Food Insecurity among Adolescent Students from 95 Countries Is Associated with Diet, Behavior, and Health, and Associations Differ by Student Age and Sex

ABSTRACTBackgroundAdolescents’ developmental tasks and challenges vary based on age, sex, and social context. Food insecurity affects adolescents, but existing research has been limited to a few country contexts and has treated adolescence as a singular developmental moment with limited consideration of potential differences in how food insecurity relates to developmental experiences based on adolescent age and sex.ObjectivesWe aimed to describe relations between student-reported food insecurity and students’ profiles of nutritional, physical activity, school absenteeism, health/mental health, and victimization experiences, and how these differ by student age and sex.MethodsUsing cross-sectional data from the Global School-based Student Health Survey, we examined adolescent reports of their food security among 337,738 students 11–18 y old from 95 countries. We identified their profiles of focal experiences, and used mixed-effects linear and logistic regression models to examine differences in these profiles by student food insecurity and how these differ by student age and sex.ResultsOf students, 25.5% aged 11–14 y compared with 30% aged 15–18 y reported food insecurity in the past 30 d. Food insecurity was associated with less frequent fruit and vegetable intake; more frequent soft drink intake; worse mental health; less physical activity; more missed school; higher odds of smoking, drinking, and using drugs; and more bullying victimization and sexual partners. Food insecurity was associated with reduced age- and sex-specific protection: greater substance use among younger adolescents, more sexual partners among older females, and greater worry among younger males. Food insecurity was also associated with increased age-specific risk: greater soft drink consumption among younger adolescents.ConclusionsAcross countries, adolescent food insecurity was associated with poorer nutritional, mental health, behavioral, and relationship profiles; these associations differed with student age and sex. Food insecurity interventions should attend to adolescent developmental stage and the gendered contexts through which adolescents navigate daily life.

Enhancing Food Security and Alleviating Poverty: Community Responses to the Poor Rice Program in Jaranguda Village, Indonesia

This study evaluates the impact of the Poor Rice Program in Jaranguda Village, located in the Merdeka District of the Karo Regency, Indonesia. The research employs a mixed-method approach, combining quantitative and qualitative analyses to comprehensively assess the program's effectiveness in addressing food insecurity, reducing household expenses, and engaging the community. Quantitative analysis of household surveys revealed a substantial reduction, averaging 30%, in monthly food expenses among program beneficiaries. Moreover, the provision of subsidized or free rice significantly decreased reported food insecurity incidents by 40%, ensuring a more stable and consistent food supply. Qualitative data from community feedback highlighted a strong sense of appreciation for the program's assistance, along with suggestions for improved distribution mechanisms and increased community engagement. These insights emphasize the need for ongoing dialogue and program adaptability to better cater to the evolving needs of the community. The findings underscore the significant impact of the Poor Rice Program in alleviating financial burdens and improving food security within Jaranguda Village. The reduction in household expenses and enhanced food security among beneficiaries signify the tangible outcomes of targeted interventions, emphasizing the importance of responsive, community-driven programs in addressing poverty-related challenges. This research contributes empirical evidence supporting the effectiveness of poverty-alleviation initiatives, providing valuable insights for policy development and future interventions in similar contexts. The findings offer a foundation for guiding community-driven programs aimed at improving the well-being of vulnerable populations.

Local practices and production confer resilience to rural Pacific food systems during the COVID-19 pandemic

Resilience of food systems is key to ensuring food security through crisis. The COVID-19 pandemic presents an unprecedented shock that reveals varying levels of resilience of increasingly interconnected food systems across the globe. We contribute to the ongoing debate about whether increased connectivity reduces or enhances resilience in the context of rural Pacific food systems, while examining how communities have adapted to the global shocks associated with the pandemic to ensure food security. We conducted 609 interviews across 199 coastal villages from May to October 2020 in Federated States of Micronesia, Fiji, Palau, Papua New Guinea, Solomon Islands, Tonga, and Tuvalu to understand community-level impacts and adaptations during the first 5–10 months of the COVID-19 crisis. We found that local food production practices and food sharing conferred resilience, and that imported foods could aid or inhibit resilience. Communities in countries more reliant on imports were almost twice as likely to report food insecurity compared to those least reliant. However, in places dealing with a concurrent cyclone, local food systems were impaired, and imported foods proved critical. Our findings suggest that policy in the Pacific should bolster sustainable local food production and practices. Pacific states should avoid becoming overly reliant on food imports, while having measures in place to support food security after disasters, supplementing locally produced and preserved foods with imported foods when necessary. Developing policies that promote resilient food systems can help prepare communities for future shocks, including those anticipated with climate change.

Household food insecurity is associated with child's dietary diversity score among primary school children in two districts in Ghana.

BackgroundDietary diversity is generally considered as a good indicator of nutrient adequacy and is influenced by various factors at the national, household, and individual levels.ObjectiveThe present study sought to determine the relationships between household food insecurity, primary caregivers’ nutrition knowledge, and dietary diversity of school-aged children in Ghana.MethodsThis forms part of a longitudinal study conducted in the Ayawaso West Municipal district in Accra (urban setting) and the Upper Manya Krobo district (rural setting) in Ghana. Data were collected from a total of 116 caregiver-child dyads using 24-h dietary recall and a short version of the US 12-month Household Food Security Survey Module. Nutrition knowledge and sociodemographic data were obtained using a structured questionnaire. Multivariable logistic regression was used to check for factors associated with children’s dietary diversity.ResultsMajority of households reported food insecurity, with a higher percentage of insecure households located in the rural area (88.9% vs. 46.5%, P ≤ 0.0001), compared to the urban setting. Diet diversity among the study children was low, with a mean (standard deviation [SD]) of 5.8 (2.1) out of 14 food groups. Children living in food insecure households were three times more likely to have received low diverse diet compared to those from food secure households (adjusted odds ratio [OR] =3.3, 95% confidence interval [CI]: 1.4–8.0). Caregivers’ nutrition knowledge was, however, not related to children’s dietary diversity.Discussion and conclusionHousehold food insecurity was a main predictor of dietary diversity among school-age children in this study. Thus, caregiver knowledge in nutrition may not be enough, particularly in the presence of food insecurity to guarantee adequate nutrition for school-aged children.

Food insecurity and substance use in people with HIV infection and substance use disorder

Background Food insecurity and substance use are common among people living with HIV (PLWH). Substance use may help people cope with hunger and thus be associated with food insecurity, but the association is uncertain. This study assessed whether, in PLWH and substance dependence, if there was an association between food insecurity and substance use. Methods: We studied adults with HIV and current substance dependence or ever injection drug use interviewed at 12 and 24 months after enrollment in a prospective cohort study. The presence of food insecurity (insufficient food quantity or quality, or anxiety about its availability) was assessed using the Household Food Insecurity Assessment Scale questionnaire (HFIAS). Unhealthy alcohol use was assessed with the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) and past 30-day other drug use with the Addiction Severity Index. Associations using repeat cross-sectional data from each of two time-points, 12 months apart, from the same participants were tested using generalized estimating equations logistic regressions. Results: The 233 participants had a mean age of 50 years and 65% were male. At the first interview, 44% reported food insecurity, 40% unhealthy alcohol use, 25% past 30-day cocaine use, and 17% past 30-day illicit opioid use. In analyses adjusted for demographics, social factors, physical and mental health function, and substance use related variables, there was no significant association between food insecurity and unhealthy alcohol use (adjusted odds ratio (aOR) = 1.06 (95% CI: 0.59, 1.87)). Those with food insecurity had higher odds of illicit opioid use (aOR = 2.5 (95% CI: 1.12, 5.58)) and cocaine use (aOR = 1.95 (CI 95%: 1.00, 3.81)). Conclusion: Food insecurity was not associated with unhealthy alcohol use but was associated with cocaine and illicit opioid use. Given the prevalence and impact substance use has on PLWH, food insecurity should be identified and addressed.

Prevalence of Social Determinants of Health Among Health System Employees.

Introduction/Objectives:Many health systems screen patients for social determinants of health and refer patients with social needs to community service organizations for assistance. However, little is known about social determinants of health among health system employees. We sought to examine the prevalence of social determinants among employees of The MetroHealth System, a large safety-net health system in Cleveland, Ohio.Methods:We invited participants in an employee wellness program to answer the same screening questions that patients answer about 9 social determinants of health, including food insecurity, financial strain, transportation difficulty, inability to pay for housing or utilities, intimate partner violence, social isolation, infrequent physical activity, daily stress, and lack of internet access. We then determined the percentage of employees who met pre-defined criteria for being at risk for each social determinant. We also examined how these percentages varied across employee job categories.Results:Of 4191 full-time employees, 1932 (46%) completed the survey. The percentage of employees at risk for each social determinant were: food insecurity (11%), financial strain (12%), transportation difficulty (4%), inability to pay for housing or utilities (10%), intimate partner violence (4%), social isolation (48%), infrequent physical activity (10%), daily stress (58%), and lack of internet access (3%). Being at risk for specific social determinants was more common among support staff compared to staff physicians and nurses. For example, the survey participants included 436 administrative support staff, a job category that includes secretaries and patient service representatives. Among this group, 20% reported food insecurity, 20% financial strain, and 17% inability to pay for housing or utilities.Conclusions:Social determinants of health are common among health system employees, especially among workers in lower paid job categories. Health systems should routinely screen employees for social determinants and adjust salaries, benefits, and assistance programs to address their social needs.

Diaper Need as a Measure of Material Hardship During COVID-19

Diaper need is a lack of reliable access to a sufficient quantity of diaper supplies. It is an essential pediatric social determinant of health measure that is useful for exploring the effects of the COVID-19 pandemic on families of young children. This study aimed to identify the predictors of diaper need and the associations between diaper need and psychosocial outcomes among underresourced families with neurodiverse children. This cross-sectional study included 129 caregivers of children aged 0-36 months who completed an online survey in early 2021, during the height of the COVID-19 pandemic. Participants completed a diaper need assessment, the Hunger Vital Signs Food Insecurity Screener, the Perceived Stress Scale, and the Infant Behavioral Questionnaire subscale. Relationships were explored using independent-samples t-tests, chi-square tests, and multiple regression analyses. Seventy-six percent of caregivers reported some diaper need, and 87.6% reported food insecurity. Greater than one third (39.5%) reported high diaper need. Common mitigation strategies included using a towel or other cloth like a diaper, not using a diaper, and keeping the child in the same diaper for longer than usual. In multivariate modeling, food insecurity, household size, and parent age were significantly associated with high diaper need. Families experiencing food insecurity were 4.24 times more likely to experience high diaper need than food-secure families. High diaper need compared to low or no diaper need was associated with increased parent perceived stress. We found high levels of diaper need and food insecurity for families during the COVID-19 pandemic. The association of high diaper need and stress indicates an inadequate supply of diapers adversely affects parent stress. Nurses may consider including diaper need in social determinants of health screening and prioritize connecting families to appropriate resources.

Sarcopenic Obesity in Older Adults: Findings From the National Health and Aging Trends Study

There is substantial heterogeneity in the impact of multimorbidity on functional, cognitive, and emotional health. Few studies, however, have examined this simultaneously across these multiple domains. We used finite mixture modeling to identify latent clusters of individuals following similar joint trajectories of multimorbidity, functional ability, cognitive performance, and depressive symptoms among 11,841 HRS respondents aged 65+ from 1998 to 2014. We identified four distinct clusters of joint trajectories: (1) 32.5% of the sample were characterized by low multimorbidity (mean = 0.60 conditions at age 65; 2.2 conditions at age 90), minimal deterioration in functional or cognitive ability, and low depressive symptoms; (2) 33.5%, had increased multimorbidity compared with the first group (mean = 2.3 at age 65; 4.0 at age 90) but minimal functional or cognitive impairment and low depressive symptoms; (3) 19.9%, had relatively low multimorbidity (mean = 1.3 at age 65 increasing to 2.8 at age 90), but exhibited worsening cognitive performance, increasing functional limitations, and moderate depressive symptoms ; and (4) 14.1%, had higher multimorbidity (mean = 3.3 at age 65 increasing to 4.6 at age 90), worsening cognitive performance, substantial functional limitation, and high depressive symptoms. Black and Hispanic race/ethnicity, lower levels of income and education, male gender, and smoking history were significantly associated with membership in classes characterized by higher multimorbidity, cognitive and functional impairment, and greater depressive symptoms. This study provides insight into the heterogenous trajectories of aging and helps identify older individuals at higher risk for poor aging outcomes across multiple health domains.

The effect of acute and chronic scarcity on acute stress: A dyadic developmental examination

BackgroundFood insecurity, obesity, and psychological stress are interrelated constructs which are thought to be connected through increased energy intake, but the underlying mechanisms for these relationships remain unclear. The current study used experimental methods to investigate how financial losses may influence acute stress in the context of food insecurity for both parents and offspring. This study also sought to examine the effect of acute stress related to financial losses on the reinforcing value of food (RRVfood) and delay discounting (DD). MethodsOne hundred and six families stratified by both offspring age (53 children aged 7–10, 53 adolescents aged 15–17) and household financial resources, visited our laboratory for three separate appointments. Each appointment included the experimental manipulation of financial gains and losses, saliva samples for cortisol assay, continuous heart rate monitoring, self-rated tension, and computer-based DD and RRVfood tasks. Participants also completed surveys to report perceived life stress level and food insecurity status. ResultsAmong all participants, financial losses were related to decreased heart rates and increased self-rated tension. Among parents reporting food insecurity, acute financial losses resulted in an increase in cortisol levels. Changes in cortisol, heart rate, and tension were not related to RRVfood or DD. ConclusionFood insecure parents are sensitive to financial losses and respond with an increase in cortisol. However, we found no evidence for a relationship between cortisol and RRVfood or DD. This sensitivity to financial losses did not extend to children or adolescents.

Late Adolescent Predictors of Homelessness and Food Insecurity During Emerging Adulthood

PurposeEconomic instability is a significant and growing problem among emerging adults in the U.S. This study identifies adolescent factors across multiple levels of influence that predict homelessness and food insecurity 5 years later. MethodsThe analytic sample (n = 2,110) completed a survey in 2015–2016 (mean age 17) that assessed a range of demographic, behavioral health, family, peer, academic, and neighborhood factors, and a follow-up survey in 2019–2020 (mean age 23) that assessed past-year homelessness and food insecurity. Logistic regression analyses were conducted for the full sample, and by race/ethnicity. ResultsAt follow-up, 7.5% of participants reported homelessness, and 29.3% reported food insecurity. Multivariate analyses indicated that only adverse childhood experiences and weaker academic orientation predicted both outcomes. Future homelessness was additionally predicted by greater exposure to substance using peers during adolescence. Identifying as Hispanic, lower maternal education, and greater neighborhood disorganization were risk factors for future food insecurity, and living with both biological parents and better mental health were protective factors. Race/ethnicity stratified models showed variations in multilevel predictors of both outcomes, except for adverse childhood experiences, which were significant across all subgroups. ConclusionsAdverse childhood experiences and weaker academic orientation emerged as the most robust predictors of economic instability in emerging adulthood. However, a range of other modifiable multilevel predictors in adolescence were identified that were unique to homelessness or food insecurity and that varied by race/ethnicity. Results suggest the need for multilevel approaches early in life to reduce risk of economic instability during emerging adulthood.

Food insecurity, food parenting practices, and child eating behaviors among low-income Hispanic families of young children

Food insecurity is associated with negative food parenting practices that may promote child obesity, including pressure to eat and food restriction. Less is known about the relationship between food insecurity and positive food parenting practices, including exposing the child to new foods and involving the child in food preparation. Further, few studies have investigated the associations between food insecurity and child eating behaviors that have been linked to poor dietary outcomes. Using baseline data collected as part of a larger pilot intervention, we examined the relationships between food security status, food parenting practices, and child eating behaviors in a predominately Hispanic, low-income sample of parents and their preschool aged children (n = 66). Between July of 2019 and 2020, caregivers recruited from 4 urban communities in Rhode Island completed assessments of household food security, food parenting practices, and four child eating behaviors: food responsiveness, emotional overeating, enjoyment of food, and satiety responsiveness. Although 46% of caregivers reported food insecurity, food insecurity was not directly associated with any food parenting practice. Children in food insecure households were rated as higher in levels of food responsiveness and enjoyment of food as compared to children in food secure households. Children in food insecure households were rated as lower in satiety responsiveness as compared to children in food secure households. Child emotional overeating did not vary by food security status. Future interventions to reduce child obesity among low-income Hispanic families should assess food security status and consider any level of food insecurity as a potential signal of unhealthy child eating behaviors.

Which financial stressors are linked to food insecurity among older adults in the United Kingdom, Germany, and the Netherlands? An exploratory study

Food insecurity among adults age 65 and older is a growing public policy concern in European countries, but the extent of the problem and the related financial stressors are unclear. The purpose of this paper is to measure the percent of food insecure individuals in a targeted sample of financially fragile older adults, and to identify associated financial stressors and socio-economic characteristics. This exploratory study is based on an online survey of 1,059 older adults experiencing financial hardship. Participants were recruited through commercial consumer panels in the United Kingdom, Germany, and the Netherlands. The proportion of financially fragile older adults reporting food insecurity ranged from 24% in the British sample, 29% in the German sample, and 35% in the Dutch sample. We identified financial stressors that contributed to food insecurity in each country sample. Having more financial stressors increased the risk of food insecurity, which was similar in each country. Within and across country samples, food insecurity is associated with financial stressors. Insights for policy makers, consumer advocates, and social services point to the value of integrating financial and food-related support services, the potential for cross-country collaboration, and efforts that take into account the particular financial circumstances of older adults.

Moderating effect of loneliness on the relationship of housing instability and food insecurity with smoking behavior

ABSTRACT Loneliness is a public health concern associated with individuals adopting various coping mechanisms to counter stressors. Stressors like social determinants of health (SDoH) risks (housing, food) have been associated with smoking. This study examines the role of loneliness on the relationship of SDoH risks with smoking. A cross-sectional study utilizing 2019 Ohio Medicaid Assessment Survey data was conducted. Multiple weighted logistic regressions were conducted to analyze the associations of loneliness and SDoH risks with smoking. Also, two models tested for the independent moderating effect of loneliness with food insecurity and housing instability on smoking. Of the 29,495 individuals who completed the loneliness questionnaire, 18% were identified as being lonely. Also, 20% and 16% of respondents reported food insecurity and housing instability respectively. Food insecurity (OR=2.10; CI=1.87–2.35), housing instability (OR=1.50; OR=1.33–1.68), and loneliness (OR=1.43; CI=1.27–1.60) were associated with greater odds of smoking. Loneliness buffered the relationship between housing instability and smoking behavior (ORinteraction=1.37; CI=1.06–1.78). In conclusion, SDoH risks and loneliness are associated with smoking. Loneliness has a moderating effect on the relationship between housing instability and smoking. These findings highlight the complex relationship of factors associated with smoking. A multi-faceted approach involving providers, health systems, local organizations, and payers is necessary.

Food Insecurity, Associated Health Behaviors, and Academic Performance Among Urban University Undergraduate Students

ObjectiveTo explore associations between food insecurity, health behaviors, and academic performance among undergraduates at a private, urban US university. MethodsA cross-sectional web-based survey was conducted among a convenience sample of New York University undergraduates. Multivariable logistic regression estimated associations of food security (using the 6-item US Household Food Security Survey Module) and health behaviors (fruit/vegetable, beverage and alcohol intakes, and sleep), self-rated health, and academic performance. ResultsOf the 257 students who completed the survey, 41% reported food insecurity. Food insecurity was associated with approximately 2-fold higher odds of sugar-sweetened beverage consumption (adjusted odds ratio, 1.97; 95% confidence interval, 1.14–3.41) and fair/poor health (adjusted odds ratio, 2.29; 95% confidence interval, 1.23–4.25). Conclusions and ImplicationsIncreased awareness of food insecurity and associated health behaviors among students has implications for higher education's provision of on-campus food support programs.

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.

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

AimsThe purpose of this study was to examine whether pandemic exposure impacted unmet social and diabetes needs, self-care behaviors, and diabetes outcomes in a sample with diabetes and poor glycemic control. MethodsThis was a cross-sectional analysis of participants with diabetes and poor glycemic control in an ongoing trial (n = 353). We compared the prevalence of unmet needs, self-care behaviors, and diabetes outcomes in successive cohorts of enrollees surveyed pre-pandemic (prior to March 11, 2020, n = 182), in the early stages of the pandemic (May–September, 2020, n = 75), and later (September 2020–January 2021, n = 96) stratified by income and gender. Adjusted multivariable regression models were used to examine trends. ResultsMore participants with low income reported food insecurity (70% vs. 83%, p < 0.05) and needs related to access to blood glucose supplies (19% vs. 67%, p < 0.05) during the pandemic compared to pre-pandemic levels. In adjusted models among people with low incomes, the odds of housing insecurity increased among participants during the early pandemic months compared with participants pre-pandemic (OR 20.2 [95% CI 2.8–145.2], p < 0.01). A1c levels were better among participants later in the pandemic than those pre-pandemic (β = −1.1 [95% CI −1.8 to −0.4], p < 0.01), but systolic blood pressure control was substantially worse (β = 11.5 [95% CI 4.2–18.8, p < 0.001). ConclusionAdults with low-incomes and diabetes were most impacted by the pandemic. A1c may not fully capture challenges that people with diabetes are facing to manage their condition; systolic blood pressures may have worsened and problems with self-care may forebode longer-term challenges in diabetes control.