US Household Food Security Survey Research Articles

Qualitative assessment of changes to university students' dietary intake by food security status in the context of COVID-19.

To explore how university students' dietary intakes changed during COVID-19, and whether these changes differed by food security status. Six hundred students attending a New Jersey public university. A cross-sectional online survey asked about student intake. Food security status was measured using the 18-item US Household Food Security Survey. Open-ended questions were content analyzed and themes were compared between food secure (FS) and food insecure (FI) students. The most frequently reported dietary changes for FI students were food source/sourcing (22.7%), food variety (19.7%), and food/meal properties (19.7%). For FS students, themes differed: no change (31.5%), food source/sourcing (31.3%), and health/nutrition (13.7%). Students indicated dietary changes during the pandemic regardless of food security status, although FI students more frequently reported smaller, less healthy, and less varied meals. Colleges and universities can provide support through enhanced outreach and assistance during emergencies or extended periods of disruption.

Food Insecurity Among Graduate Students and Postdoctoral Trainees

Food insecurity on college campuses has emerged as an urgent public health priority; however, there has been a lack of studies focused on graduate students or postdoctoral trainees, particularly those enrolled at private academic institutions. To estimate the prevalence of and factors associated with food insecurity among graduate students and postdoctoral trainees at a private academic university in Boston, Massachusetts. In this cross-sectional survey study, a survey on food insecurity was sent to graduate students and postdoctoral trainees at 3 health-focused graduate schools at Harvard University during the end of the spring 2023 academic term (April to June). Participants were studying medicine, dental medicine, or public health. Data analysis was performed from July to September 2023. Sociodemographic characteristics of graduate students and postdoctoral trainees. The primary outcome was food insecurity as assessed using the US Household Food Security Survey Module. Food insecurity also encompassed low and very low food security. Bidirectional stepwise logistic regression models were conducted to estimate the factors associated with food insecurity for graduate students and postdoctoral trainees. The analytic sample included 1745 participants (response rate, 55%): 1287 were graduate students and 458 were postdoctoral trainees. The median age of respondents was 29.0 (IQR, 7.0) years, and more than half (1073 [61.5%]) identified as female. A total of 694 respondents (39.8%) identified as Asian, 625 (35.8%) as White, and 426 (24.4%) as being of other race or ethnicity. The prevalence of food insecurity was 17.4% (224 of 1287) among graduate students and 12.7% (58 of 458) among postdoctoral trainees. Among graduate students, factors associated with food insecurity included being Asian (OR, 1.06 [95% CI, 1.01-1.11]) or of other race or ethnicity (OR, 1.07 [95% CI, 1.02-1.13]), receiving financial aid (OR, 1.09 [95% CI, 1.05-1.13]), and having housing instability (OR, 1.53 [95% CI, 1.45-1.61]). Among postdoctoral trainees, factors associated with food insecurity included receiving Supplemental Nutrition Assistance Program benefits (OR, 1.59 [95% CI, 1.28-1.97]), having housing instability (OR, 1.33 [95% CI, 1.22-1.45]), and not owning a car (OR, 1.11 [95% CI, 1.04-1.18]). In this study, a substantial proportion of graduate students and postdoctoral trainees at a private academic institution experienced food insecurity during the academic year. These findings underscore the need for national and institutional interventions to address the complex, structural factors related to food insecurity in these distinct populations.

Beyond Economic Barriers: Conceptualizing Food Insecurity among Resettled Refugees Living in the United States

The US Household Food Security Survey Module (HFSSM) is the most common survey tool to measure food security status at the national level. No previous studies have sought to establish its content validity for measuring food security among resettled refugees living in the US. This paper explores this dimension of the HFSSM through a qualitative grounded study of food management experiences among resettled refugees in Vermont. Analysis of the data revealed that non-financial barriers restricted participants’ food security, especially for recent arrivals. These findings present potential problems of content validity for HFSSM questions, and reveal the importance of considering food security through financial and non-financial domains.

Food insecurity and health-related quality of life among a nationally representative sample of older adults: cross-sectional analysis

BackgroundFood insecurity is a significant health issue among older adults and contributes to poorer quality of life and mental health. However, limited evidence is available among older adults. Thus, the study evaluated the associations between food security and multiple outcomes related to health-related quality of life. We examined whether participants’ sex and participation in the federal Supplemental Nutrition Assistance Program (SNAP)/or receiving the Food Stamp program might modify these associations.MethodsCross-sectional analysis of the 2007–2012 National Health and Nutrition Examination Surveys (NHANES). A sample of 3,375 adults aged ≥ 60 years with household incomes ≤ 300% of the federal poverty level (FPBL). Food security was assessed using the 18-item US Household Food Security Survey Module and categorized as food security, marginal food security, and food insecurity. Outcomes were the CDC Health-Related Quality of Life measures (HRQOL-4).ResultsApproximately 8% experienced marginal food security and 12% experienced food insecurity. Over the past month, food insecurity was significantly associated with ≥ 16 days of poor physical health (OR 1.88, 95% CI 1.23, 2.85, P-trend = 0.005), ≥ 16 days of poor mental health (OR 2.22, 95% CI 1.50, 3.28, P-trend < 0.0001), and ≥ 16 days of feeling anxious (OR 3.33, 95% CI 2.30, 4.81, P-trend < 0.0001) after multivariate adjustment. The association between food insecurity and poor physical health was stronger in females (P-interaction = 0.02). There was no evidence for effect modification in any of these associations among those receiving benefits from the federal SNAP/Food Stamp program.ConclusionsFood insecurity was positively associated with multiple adverse health outcomes. Public health programs and policies targeted for older adults are needed to mitigate the extent of food insecurity to promote overall health and well-being.

Household Food Insecurity Is Associated With Physical Activity in Youth and Young Adults With Diabetes: A Cross-Sectional Study.

Physical activity (PA) is essential for optimal diabetes management. Household food insecurity (HFI) may negatively affect diabetes management behaviors. The purpose of this study was to cross-sectionally examine the association between HFI and PA in youth and young adults (YYA) with type 1 (N = 1998) and type 2 (N = 391) diabetes from the SEARCH for Diabetes in Youth Study. HFI was measured with the US Household Food Security Survey Module. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate-intensity PA (excluding walking), vigorous-intensity PA, moderate- to vigorous-intensity PA, and total PA were estimated as minutes per week, while time spent sitting was assessed in minutes per day. All were modeled with median regression. Meeting PA guidelines or not was modeled using logistic regression. YYA with type 1 diabetes who experienced HFI spent more time walking than those who were food secure. YYA with type 2 diabetes who experienced HFI spent more time sitting than those who were food secure. Future research should examine walking for leisure versus other domains of walking in relation to HFI and use objective PA measures to corroborate associations between HFI and PA in YYA with diabetes.

Food Insecurity Predicts Magnitude of Early BMI Change in a Pediatric Weight Management Intervention.

The aim of this study was to estimate the prevalence of food insecurity among children with overweight/obesity presenting for weight management treatment and examine whether food insecurity predicts early change in body mass index (BMI), expressed as a percentage of the 95th percentile (%BMIp95). Children (N = 69; ages 3-18 years) presenting to a hospital-based pediatric weight management intervention and 1 parent/guardian per child (N = 69) were included. At the first appointment, parents/guardians completed the US Household Food Security Survey Module: Six-item Short Form and a demographics questionnaire. Height and weight of the children were measured at the first and third appointments to calculate %BMIp95. Among participating families, 29.0% reported experiencing food insecurity. Controlling for the ratio of income to poverty, 11.4% of the variance in %BMIp95 change from the first to third appointments was accounted for by food insecurity, ▵F (1, 66) = 8.46, p = 0.01. Children with greater food insecurity demonstrated a smaller magnitude of %BMIp95 decrease, representing a small-to-medium effect size within the context of the regression model (f2 = 0.13). A high proportion of families with children receiving weight management treatment reported experiencing food insecurity in comparison with US households with children. There may be unique characteristics of food insecurity, as opposed to household income alone, that explain the smaller magnitude of BMI decrease observed early in treatment. Future research should explore complex associations among food insecurity, income, BMI, and race over time.

Exploring Sociodemographic and Chronic Disease Factors Associated With Chronic, Seasonal, Intramonthly, and Intermittent Presentations of Food Security Instability

BackgroundFood insecurity impacts 13.5 million US households yearly. Although food security instability (FS-I) can have many temporal presentations, these are not measured in the current US Household Food Security Survey Module. ObjectiveExplore sociodemographic and chronic disease correlates of 4 FS-I types (chronic, seasonal, intramonthly, and intermittent) using a 3-item US Household Food Security Survey Module instability supplement. DesignThis study was a secondary analysis of cross-sectional survey pilot data collected to validate the US Household Food Security Survey Module instability supplement. Participants and settingAdults at risk for food insecurity (n = 420) were recruited and answered the survey on their households’ behalf from April to June 2021. The participants were recruited from 7 community organizations from 5 states (California, Florida, Maryland, North Carolina, and Washington). Main outcome measuresThe main outcomes were the odds of having a chronic, seasonal, intramonthly, or intermittent FS-I score ≥1 based on several sociodemographic factors and having ≥1 chronic disease. Statistical analyses performedDifferences among the 4 FS-I types were analyzed using contingency tables and χ2 tests of independence. Then, mixed-effects logistic binary and conditional regressions were run for each FS-I type using clustering by state and odds ratios and 95% CI to interpret results. ResultsThe most common FS-I type experienced by the sample was intramonthly (n = 183 [43%]). Nonchronic food insecurity was most likely to happen during the winter, at the end of the month, or randomly with no certain time frame. FS-I in any form was associated with low income, chronic FS-I was associated with younger age and male sex, seasonal FS-I was associated with having no government-subsidized health insurance and females, intramonthly FS-I was associated with participation in nutrition assistance programs, and intermittent FS-I had lower odds among Hispanic/Latino households. ConclusionsFurther research is needed to explore other FS-I correlates and establish causative relationships; however, these results can be used with clinical judgment for targeted food insecurity screening and treatment.

The Importance of Screening for Food Insecurity in Children with Sickle Cell Anemia: An Ancillary Study to the Severe Acute Malnutrition Feasibility Trial in Nigeria

Introduction Household food insecurity-lacking access to, or having uncertain access to, food that meets a person's dietary needs-is a longstanding problem in Nigeria that has continued to worsen in recent years. One of its most severe consequences is malnutrition, particularly affecting children due to their high nutrient demand coupled with higher energy expenditure. Even in high-income countries, such as the United States, many children with sickle cell anemia have lower weights and heights than their healthy peers. Due to their elevated nutrient requirements, children with sickle cell anemia may be at an even greater risk of malnutrition when faced with limited access to adequate food. The relationship between childhood food insecurity and malnutrition has been previously studied in younger children in Nigeria, but rarely in older children, and to our knowledge, never in older children with sickle cell anemia. We tested the hypothesis that there is a direct association between increased food insecurity and more severe malnutrition (lower body mass index [BMI] z-score) in older children with sickle cell anemia in Nigeria. Methods This was a planned analysis of the data of children enrolled in a feasibility trial for managing severe acute malnutrition in older children with sickle cell anemia in Nigeria (SAMS trial; #NCT03634488). In this study, children 5-12 years old with sickle cell anemia and uncomplicated severe acute malnutrition (BMI z-score &amp;lt;-3.0) were randomly assigned to receive either supplemental ready-to-use therapeutic food (RUTF) only or RUTF combined with moderate fixed-dose hydroxyurea therapy for 12 weeks. Baseline anthropometric data were obtained for each participant. Upon enrollment in the trial, the participants' caregivers completed the US Household Food Security Survey Module (HFSSM). Using the eight questions in the childhood portion of this standardized survey, we categorized the participants into three food security statuses: food security (0-1), low food security (2-4), and very low food security (5-8). Childhood food security scores were also measured as a continuous variable on a scale of 0-8, with higher scores indicating greater food insecurity. We constructed a linear regression model to estimate the association between childhood food insecurity and baseline BMI z-score. Results Data were collected between August 2021 and May 2022. The median age of the 108 participants in the study was 10.3 years (IQR 8.8-11.5). Most participants had low (55%) or very low (34%) food security. BMI z-score was not associated with categorical food security status (p=0.108). However, higher food insecurity as a continuous variable was associated with a lower BMI z-score (Pearson correlation -0.23, p=0.015; Figure 1). In a multivariable linear regression with sex, age at study entry, total hemoglobin, employment status, and head of household educational status, the childhood food insecurity score was negatively associated with the BMI z-score (Beta coefficient = -.05, p=0.047). Conclusions Our study reveals a high prevalence of food insecurity among older children with sickle cell anemia in Nigeria. Moreover, children experiencing higher food insecurity also exhibited more severe malnutrition, as evidenced by their lower BMI z-scores. Based on these results, we have started implementing food insecurity assessment as routine medical care in children with sickle cell anemia at multiple clinics in northern Nigeria. Children experiencing higher levels of food insecurity are referred to nutritional counseling, where they receive guidance on locally available nutrient-dense foods and preparation strategies. Figure 1.The predicted baseline body mass index z-score with 95% confidence intervals based on childhood food insecurity scores from a linear regression model of the participants in the SAMS trial.

Time-Trends in Food Insecurity Among US-Born and Foreign-Born Hispanic Adults by Language Use: An Analysis of National Health and Nutrition Examination Survey Data, 1999-2018

BackgroundHistorically, food insecurity prevalence has been higher in Hispanic households than in non-Hispanic White households. Food insecurity prevalence among Hispanic adults, US-born and foreign-born, may vary by language use. ObjectiveTo explore whether or not the relationship between language use and food insecurity varied over time (1999-2018) among US-born and foreign-born Hispanic adults. DesignTrends analysis and multivariable logistic regression modeling using pooled cross-sectional data. Participants and settingFifteen thousand sixty-two Hispanic adults participating in the United States National Health and Nutrition Examination Survey (1999-2018). Main outcome measuresFood insecurity prevalence, assessed with the US Household Food Security Survey Module. Statistical analysisUnadjusted food insecurity trends from 1999 to 2018 by language use (mostly English, both languages equally, or mostly Spanish) among US-born and foreign-born Hispanic adults were analyzed using piecewise-linear regression of log prevalence rates. Multivariable logistic regression models adjusted for sociodemographic characteristics and with an interaction term between language use and time were used to determine if odds of food insecurity among US-born and foreign-born Hispanic adults varied by language use between 1999 and 2018. ResultsHispanic adults’ food insecurity prevalence followed an upward linear trend from 1999 to 2018; this was significant for US-born mostly English-speakers (P < 0.001), US-born mostly Spanish-speakers (P = 0.013), and foreign-born mostly Spanish-speakers (P < 0.001). In fully adjusted logistic regression models, foreign-born Hispanic adults who spoke both languages equally (odds ratio 1.8, 95% CI 1.2 to 2.6) and those who spoke mostly Spanish (odds ratio 1.9, 95% CI 1.4 to 2.8) had significantly higher food insecurity odds, compared with mostly English-speakers. No variations in associations across time were observed between language use and food insecurity (interaction P value > 0.1). ConclusionsHispanic adults’ unadjusted food insecurity trends from 1999 to 2018 varied by language use. When adjusted for sociodemographic characteristics and compared with mostly English-speakers, food insecurity odds were significantly higher only among foreign-born Hispanic adults who spoke either both languages equally or mostly Spanish. Food assistance programs should linguistically adapt their services for Hispanic adults.

710-P: Material-Needs Security and Food Insecurity in Adults with Type 2 Diabetes in Lebanon

Food insecurity is known to impair diabetes self-management and clinical outcomes. Little is known about the prevalence and social determinants of food insecurity among people with type 2 diabetes (T2DM) in the Middle East and North Africa (MENA) region. Thus, the aim of this study was to assess food insecurity and its relationship with material needs security in Lebanese adults with T2DM of low socioeconomic status. Subjects with T2DM (n=299) were recruited from primary health care centers in Lebanon; sociodemographic and material need variables were collected using self-reported questionnaires. Food insecurity was assessed using the validated US Household Food Security Survey Module: Six-Item Short Form (USDA, 2012). Around 25% of the sample were food insecure. Compared to the food secure group, there were significantly (p&amp;lt;0.05) more participants who were females (58% vs. 44%), and who had low education level (82% vs. 58%) low income (49% vs. 24%), and no health insurance (65% vs. 49%), compared to the food secure group. Sum of material needs security was lower in the food insecure group (7.8±2.0 vs. 9.4±2.1, p&amp;lt;0.05). Results from the fully adjusted logistic regression model showed that material needs security (OR: 1.26; 95% CI: 1.06-1.49; p&amp;lt;0.007) and higher income (OR: 3.34; 95% CI: 1.39-8.05; p&amp;lt;0.007) were independent predictors of food security. Our study highlights the importance of material needs in achieving food security in T2DM in the MENA region. Further research is needed to explore other social determinants of health in this population and potential pathways/mechanisms to guide programs for effective interventions. Disclosure M.Bassil: None. O.Sukkarieh: None. L.E.Egede: None.

Association Between Material Hardship in Families With Young Children and Federal Relief Program Participation by Race and Ethnicity and Maternal Nativity

Even brief periods of hardship during early childhood may have lifelong consequences. Prior cross-sectional research limited to respondents with English proficiency and internet access during the COVID-19 crisis documented families with young children that struggled to afford basic needs like food and rent. Few studies have examined experiences of families with young children by race and ethnicity and maternal nativity. To examine the association of COVID-19 relief programs with the mitigation of household food insecurity among families with young children, as well as being behind on rent and disparities in program receipt. This cohort study used data from the ongoing repeat cross-sectional Children's HealthWatch study comprising families surveyed at baseline (January 1, 2018, to March 20, 2020) and during the COVID-19 crisis (September 1, 2020, to June 30, 2021). Baseline questionnaires were administered face to face to caregivers of children aged 48 months or younger in English or Spanish in emergency departments or primary care clinics in 5 US cities. The follow-up questionnaires were administered via telephone. Supplemental Nutrition Assistance Program (SNAP) participation or receipt of at least 1 Economic Impact Payment (EIP; ie, stimulus check) during the COVID-19 crisis. The primary outcomes were household food insecurity (assessed via the US Household Food Security Survey Module: Six-Item Short Form) and being behind on rent. Logistic and binomial regression models were used to calculate adjusted odds ratios (aORs) and unadjusted and adjusted prevalence ratios (PRs). Of 1396 caregiver-child dyads (20.3% response rate), race and ethnicity data were available for 1357 caregivers: 514 (37.9%) were Black, non-Latino; 558 (41.1%) were Latino; 230 (16.9%) were White, non-Latino; and 55 (4.1%) were of other non-Latino race or ethnicity. Among 1390 responses with nonmissing data, 417 children (30.0%) had an immigrant mother, and among 1388 responses, 1238 (33.5%) were publicly insured. During the crisis, 467 of 1395 respondents (33.5%) reported household food insecurity, and 567 of 1391 respondents (40.8%) reported being behind on rent. Families with immigrant mothers had lower odds of EIP and SNAP participation than families with US-born mothers (eg, aOR, 0.07 [95% CI, 0.05-0.12] for both EIP and SNAP vs neither), despite being more likely to report household food insecurity (adjusted PR [aPR], 1.48 [95% CI, 1.28-1.71]) and being behind on rent (aPR, 1.14 [95% CI, 1.00-1.30]). Families with Black (unadjusted PR [uPR], 1.40 [95% CI, 1.08-1.82]) or Latino (uPR, 1.54 [95% CI, 1.19-1.98]) caregivers or caregivers of other race and ethnicity (uPR, 1.67 [1.12-2.49]) were also more likely than families with White, non-Latino caregivers to experience household food insecurity or being behind on rent (families with Black caregivers: uPR, 2.02 [95% CI, 1.58-2.58]; families with Latino caregivers: 1.68 [95% CI, 1.30-2.16]; families with caregivers of other race or ethnicity: uPR, 1.94 [95% CI, 1.34-2.80]). Adjustment for covariates and differential participation in relief programs did not entirely account for these disparities. The results of this cohort study suggest that the COVID-19 crisis exacerbated preexisting inequities in food insecurity and difficulty paying rent according to race and ethnicity and maternal nativity and that equity-focused policy changes are needed to ensure that all children and their families in the US can afford basic needs for optimal health.

Food insecurity is associated with an unhealthy lifestyle score in middle- and older-aged adults: findings from the EPIPorto cohort.

The association of food insecurity with the combined effect of lifestyles is still limited. This study evaluated the association between food insecurity and a lifestyle score in middle- and older-aged adults. A cross-sectional study (2013-2016) was performed among 595 individuals (≥ 50 years) from the EPIPorto cohort (Porto, Portugal). Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Information on fruit and vegetable consumption (F&V), physical activity (PA) practice, tobacco smoking, and alcohol consumption were included in a lifestyle score. Those with F&V < five portions/day, < 150min/week of moderate-intensity PA or < 75min/week of vigorous-intensity PA, current smokers, consumers of > one drink of alcoholic beverages in women, and > two in men were assigned with one point; all the others had nil points. The score could range from 0 to 4, and was further categorised into three categories. Food insecurity was positively associated with an unhealthy lifestyle profile (OR = 2.272; 95%CI:1.079-4.782), independently of the adjustment variables. Analysing each lifestyle component, food insecurity was associated with low PA practice (OR = 2.365; 95%CI:1.020-5.485). Individuals from food insecure households were more likely to have an unhealthy lifestyle profile. Public health strategies should be developed among food insecure individuals to promote healthy lifestyles.

Perspectives of Food Insecurity and Service Delivery amongst Emergency Food Relief Clients in a Regional City in Victoria, Australia

This cross-sectional study examined the experiences of people accessing Emergency Food Relief (EFR) in the regional city of Ballarat, Victoria, Australia, including determinants, impacts of food insecurity, and service delivery recommendations. The forty-one item survey examined demographics, food security status (six-item adult US-Household Food Security Survey Module), food acquisition, use of charitable food services, and self-rated health. Adults n = 100 accessing meal programs and/or EFR services from three EFR organisations in 2018 were surveyed. Ninety-seven percent of participants received government social security payments. Food insecurity prevalence was 92% (USDA-HFSSM 6 item); of these, 63% were experiencing very low food security. Over half (54%) of households with children (n = 26) reported being sometimes unable to feed their children balanced meals and 50% indicated that they were not eating enough. Participants (47%) relied on EFR services for food between one and five years. Poor self-rated dental health was expressed by over 50% of participants and 97% indicated the importance for services to provide healthy food. Food insecurity prevalence was high and chronic among adults receiving EFR services in a large regional Australian city. Recipients’ poor dental health, chronicity of use of services for food assistance, and calls for healthier food suggest more was needed to secure pathways out of food insecurity. The chronicity of reliance on EFR is a concern. The results of this study are likely to be of interest to providers and funders of EFR, policy makers, academics, and client advocates. Whilst the provision of EFR is not a sustainable solution to the problem of food insecurity, scope exists to improve service delivery to uphold principles of dignity, choice, and access to nutritious food. Furthermore, this highlights that the key strategies to mitigate food insecurity lie beyond simply feeding people.

DELIVERING FOOD RESOURCES AND KITCHEN SKILLS TO OLDER ADULTS WITH FOOD INSECURITY AND HYPERTENSION

Abstract Non-Hispanic Black adults experience higher rates of food insecurity, poor diet quality, and hypertension compared with their non-Hispanic White counterparts. Delivering Food Resources and Kitchen Skills (FoRKS) is an integrated intervention that concurrently addresses food insecurity, nutrition literacy, and chronic disease self-management among older patients at a Federally Qualified Health Center. Two clinical dietitians led virtual hypertension self-management, cooking skills, and nutrition education classes twice per week for 16 weeks. Participants registered for classes, ordered free meal ingredients, and received encouragement from the dietitians through the FoRKS mobile technology application. This study presents diet quality descriptive results from the FoRKS pilot intervention conducted at Eskenazi Health from September 2021 to January 2022 in Indianapolis, Indiana. Participants (n=13) with hypertension (systolic blood pressure ≥120 mm Hg) and who identified as food insecure per the 18-item US Household Food Security Survey Module completed the 2018-version of the National Cancer Institute’s Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool at baseline and post-intervention assessments. Healthy Eating Index (HEI)-2015 scores range from 0-100 and were calculated from ASA24 data. Participants were non-Hispanic Black (n=12) or non-Hispanic White (n=1) with mean age 58 years (range 53-65 years). Mean±SD HEI-2015 scores improved from 51.5±11.9 at baseline to 55.2±12.5 after the intervention. This preliminary data supports further investigation into the efficacy of integrated lifestyle interventions, i.e., FoRKS, using a randomized controlled study design. Addressing food and culinary skills can lead to improvements in diet quality that may translate to improved disease management among diverse older adults.

Assessing the association of sustainable agriculture with rural household food security (considering ecological, economic, and social aspects).

Due to the importance of sustainability in the world, we follow the missing pieces of the puzzle of sustainable agriculture and food security as a huge gap in the literature. To achieve this goal, a survey was analyzed to assess the linkage between these two concepts in the rural areas in Lorestan province in Iran. The status of food security was assessed using US Household Food Security Survey Module (HFSSM). A standard questionnaire extracted from the related literature was applied to calculate sustainability indicators. The results showed that the status of food security among households with no children (70%) was better than those with one or more children (28%). According to the Tobit model, none of the sustainability dimensions had a significant association with food insecurity. The results support the fact that the assessment of agricultural sustainability at the microeconomic level, short-term period, and a small, specified location cannot lead to reliable results due to the similar behaviors of farmers in these areas. The low level of agricultural sustainability is due to the lack of macroeconomic policies in the region to promote and disseminate the principles of sustainability, lack of plans and actions to promote sustainability by stakeholders and policymakers, ignorance of the target community, as subsistence producers who fall into a deprivation trap. The results suggest that policymakers should use two short-term and long-term strategies to improve the level of agricultural sustainability and increase food security status.

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.

Evaluating the association between food insecurity and risk of nephrolithiasis: an analysis of the National Health and Nutrition Examination Survey.

This study aimed to investigate the relationship between self-reported food security and kidney stone formation. Data were collected from the National Health and Nutrition Examination Survey (NHANES), a database representative of the United States population. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Characteristics of patients were compared using the Chi-square test and the student t-test. Multivariate logistic regression was performed using a multi-model approach. We analyzed 6,800 NHANES survey respondents. 37.2% of respondents were categorized as having "low food security" (scores 2-4) and 24.0% having "very low food security" (scores 5-6). 8.4% of respondents had a history of kidney stones. We found that people with very low food security had a 42% increased likelihood of developing kidney stones compared to those with high or marginal food security, after controlling for race, age, and comorbidities (OR 1.42; 95% CI 1.01-1.99). Between the different food security groups, no significant differences were observed in age, race/ethnicity, body mass index, gout history, osteoporosis history, or coronary artery disease history. Lower food security was associated with slightly younger age (< 1year difference, p = 0.001), higher poverty-income ratio (p = 0.001), and many comorbidities, including kidney stones (p = 0.007). Our study provides evidence for an association between food access and the risk of kidney stone disease. Given these findings, food insecurity should be investigated as a modifiable risk factor for the development of kidney stone disease.

Prevalence of Food Insecurity in a Community College District: Relationship Between Food Security and Grade Point Average

ABSTRACT The authors sought to identify the prevalence of food insecurity in a community college district during the COVID-19 pandemic. The team also investigated the association food insecurity had with academic performance. A sample of 238 individuals completed the survey, including a demographic questionnaire and the Adult Food Security Survey Module, a subset of the US Household Food Security Survey Module. The study found that 52% of the participating students reported food insecurity. Students of color were more likely to identify as food insecure. In addition, results indicate an association between being food secure and scoring a GPA of 3.5 or higher. These findings support past studies indicating that food insecurity was high in the community college population. The findings also support past results indicating a link between food security and academic performance.

The association of food insecurity with tooth decay and periodontitis among middle-aged and older adults in the United States and Korea.

Food insecurity is an important social determinant of health, but there is limited understanding of its relationship with adult oral health. This study examined the associations between food insecurity and dental diseases (caries and periodontitis) among middle-aged and older adults in the United States and South Korea. This study focused on middle-aged (40-59 years) and older adults (>59 years) who participated in the 2011-2016 US National Health and Nutrition Examination Surveys (NHANES) or the 2013-2015 South Korean NHANES. The exposure was food insecurity severity (food secure/early-stage food insecurity/middle-stage or severe food insecurity) assessed using the 18-item US Household Food Security Survey Module. The two outcomes were any untreated tooth decay and periodontitis measured using the Modified Community Periodontal Index of Treatment Needs. Covariate-adjusted odds ratios (OR) with 95% confidence intervals (CI) were generated using multivariable logistic regression models. Middle or severe food insecurity was associated with significantly higher odds of having untreated tooth decay than no food insecurity, but only among middle-aged adults in the United States (OR: 1.4, 95% CI 1.2, 1.9; P= .037) and Korea (OR=1.8; 95% CI:1.0, 3.2; P= .036) and older adults in the United States (OR: 2.6, 95% CI 1.7, 4.0; P< .001). The associations between food insecurity and periodontitis were inconsistent across age group and country. Differing cultural norms and access to dental services in the United States and South Korea may influence the relationship between food insecurity and oral health. Future research should explore how addressing food insecurity could help to promote the oral health of middle-aged and older adults in diverse sociocultural contexts.

Household food insecurity is associated with diabetic ketoacidosis but not severe hypoglycemia or glycemic control in youth and young adults with youth-onset type 2 diabetes.

To examine the association between household food insecurity (HFI), glycemic control, severe hypoglycemia and diabetic ketoacidosis (DKA) among youth and young adults (YYA) with youth-onset type 2 diabetes. This cross-sectional study included 395 YYA with type 2 diabetes from the SEARCH for Diabetes in Youth Study (2015-2019). HFI was reported by young adult participants or parents of minor participants via the US Household Food Security Survey Module. Glycemic control was assessed by HbA1c and analyzed as a continuous and categorical variable (optimal: <7.0%, suboptimal: ≥7.0%-9.0%, poor: >9.0%). Acute complications included self-reported severe hypoglycemia or DKA in the last 12months. Adjusted logistic and linear regression were used for binary and continuous outcomes, respectively. Approximately 31% reported HFI in the past 12months. Mean HbA1c among those with HFI was 9.2% compared to 9.5% without HFI. Of those with HFI, 56% had an HbA1c >9.0% compared to 55% without HFI. Adjusted models showed no associations between HFI and glycemic control. Of those with HFI, 14.4% reported experiencing DKA and 4.7% reported severe hypoglycemia. YYA with HFI had 3.08 times (95% CI: 1.18-8.06) the odds of experiencing DKA as those without HFI. There was no association between HFI and severe hypoglycemia. HFI was associated with markedly increased odds of DKA but not with glycemic control or severe hypoglycemia. Future research among YYA with type 2 diabetes should evaluate longitudinally whether alleviating HFI reduces DKA.