US Household Food Security Research Articles

1115-P: Household Food Insecurity and Cognitive Function in Youth and Young Adults with Type 1 Diabetes

Household food insecurity (HFI) is the limited or uncertain availability of nutritionally adequate and safe foods and has been associated with decreased cognitive function in persons without diabetes. In persons with diabetes, little is known about the impact of HFI, but cognitive function is known to decline with diabetes duration and poorer glycemic control. We evaluated the cross-sectional association of HFI with cognitive function in youth and young adults (YYA) with type 1 diabetes (T1D), focusing on executive function as measured with the NIH Toolbox Cognition Battery (score range 39-146) and a potential interaction of HFI with glycemic control (high risk >9% vs. optimal/suboptimal ≤9% HbA1c). Age-adjusted composite fluid cognition score was modeled using multivariable linear regression, with HFI (≥3 affirmations on US Household Food Security Survey Module) as the predictor, controlling for covariates. Among 1,272 YYA with T1D (mean age 21, diabetes duration 11 years, 57% non-Hispanic white), 55% had high-risk glycemic control and 18% were food insecure. Food insecure T1D YYA had a 2.7 (SD=1.2) lower fluid cognition score than their food secure peers (93.7 vs. 96.4, p=0.03). Adjustment for sex, race/ethnicity, diabetes duration, site, and glycemic control attenuated this association (β=1.2, p=0.30). However, glycemic control turned out to modify the association of HFI with cognition (multiplicative interaction in adjusted model p<0.01). Among YYA with HbA1c ≤9%, food insecure individuals had a lower mean fluid cognition score than the food secure (99 vs. 104, p<0.02); for YYA with high-risk glycemic control, no association was observed. In this cross-sectional study, food insecurity has a detrimental relationship with cognition among T1D YYA, particularly among those with optimal/suboptimal glycemic control levels. Longitudinal research is needed to further delineate the temporal relationships between household food insecurity, glycemic control, and cognition. Disclosure A. D. Liese: None. B. A. Reboussin: None. A. S. Shah: None. S. M. Marcovina: None. L. M. Dolan: None. D. Dabelea: None. C. Pihoker: None. J. A. Mendoza: None. A. D. Brown: None. A. Shapiro: None. E. A. Frongillo: None. G. Wilkening: None. J. Fridriksson: None. A. Merchant: None. L. Henkin: None. E. T. Jensen: None. Funding National Institutes of Health (1R01DK117461, 1UC4DK108173)

Abstract P077: Trends In Prevalence Of Cardiometabolic Diseases By Food Security Status, 1999-2016

Introduction: Cardiometabolic diseases (CMDs), which include coronary heart disease (CHD), hypertension (HTN), type 2 diabetes (DM) and obesity, are an interrelated set of highly preventable conditions. Food insecurity, another pervasive public health issue, is associated with CMDs. We aim to characterize the prevalence of CMD by food security (FS) status over time. Hypothesis: Prevalence of DM and obesity increased while that of HTN and CHD decreased over time, with pervasive disparities among FS status. Methods: Adults ≥20 years from the 1999-2016 NHANES were included in this analysis. CMD outcomes included DM (prior diagnosed or FPG≥126 mg/dL or HbA1c ≥6.5%), CHD (prior diagnosis of myocardial infarction, angina or any other type of CHD), obesity (BMI ≥30 kg/m 2 ) and HTN (≥1 of the following: systolic blood pressure (BP) ≥130 mmHg, diastolic BP ≥80, or currently taking BP medications). FS status was measured through the US Household Food Security Survey Module and recategorized into three levels (full, marginal and low). All estimates were age-standardized to the 2010 US census population. All analyses accounted for the complex survey design. Logistic regressions were conducted to calculate P-values. Results: Our sample included 46,879 adults (79.5% of full, 7.67% of marginal and 12.8% of low FS). HTN prevalence decreased from 50% to 44.4% among the full FS group and from 54.9% to 50.4% among the marginal group (P-trends<0.001, P-interaction=0.009). CHD prevalence decreased from 6.33% to 4.81% (P-trend<0.001) among the full group. Obesity prevalence increased from 31.0% to 38.0% among the full group and from 38.3% to 50.5% among the low group (P-trend<0.001, P-interaction=0.02). DM prevalence increased from 8.30% to 11.3% for the full group, from 14.9% to 21.8% for the marginal group and from 14.8% to 20.1% for the low group (P-trend<0.001) ( Figure ). Conclusion: From 1999 to 2016, the prevalence of CMDs were lowest among participants who were in full FS group and disparities by FS status persisted or worsened.

Inpatient Food Insecurity in Caregivers of Hospitalized Pediatric Patients: A Mixed Methods Study.

Among US households with children, 14% are food insecure. Household food insecurity (FI) is associated with poorer health outcomes and increased hospital admissions. There is less known about caregivers' ability to obtain adequate food during hospitalization (inpatient FI). We conducted a mixed methods study of primary caregivers of hospitalized children 0 to 18 years. A modified US Household Food Security Survey was used to identify inpatient FI. Associated factors were identified using logistic regression adjusted for covariables. Caregiver semistructured interviews were conducted to elicit perceptions on food accessibility and effects of and solutions for inpatient FI. The prevalence of inpatient FI was 43%. Household FI was present in 38% of families. Inpatient FI was associated with household FI (P < .01). In multivariable analysis, odds of inpatient FI were increased among caregivers with annual household income <$30,000 (adjusted odds ratio [aOR] 2.14), public transportation use (aOR 6.33), living >30 miles from the hospital (aOR 2.80), self-rated fair/poor health (aOR 3.31), maternity leave (aOR 4.75), and past/current Supplemental Nutrition Assistance Program benefit utilization (aOR 2.52). Qualitative analysis identified barriers to food access, such as lack of affordable options, and found that caregivers made sacrifices for their hospitalized child, including skipping meals. Caregivers viewed their presence at their child's bedside and personal nourishment as important factors affecting their child's care. Inpatient FI may affect a significant proportion of hospitalized children's caregivers. Pediatric hospitals should ensure that caregivers have access to food in order to fully engage in their child's care.

Nutritional Education and Its Effects on Household Food Insecurity in Southeastern Iran.

Background:Food insecurity can affect health directly or indirectly through its impact on nutritional status. We aimed at determining the effects of nutrition education intervention on household food insecurity in Zahedan, southeast Iran.Methods:The study was conducted using multi-stage sampling method. The first stage was a cross-sectional investigation whereby 2,160 households were studied in Zahedan in 2015. The prevalence of food insecurity was determined and food-insecure households were identified. Household food security status was assessed through the 18-item US Household Food Security Survey Module. In the second stage, based on the determined sample size of 150 households in each group, eligible households were randomly divided into the intervention and control groups. Before the educational intervention, questionnaires including demographic and socioeconomic information were completed for both groups. Then, data analysis was performed and the intervention was conducted on the intervention group. Six months post-intervention, a final assessment was made by interviewing the two groups to complete demographic, socioeconomic, and household food security questionnaires.Results:The prevalence of food insecurity in the 2,160 households was 58.8%. After the intervention, the number of food-insecure households diminished by 22% in the intervention group, and these households were assigned to the food secure category. After controlling the confounding variables, the educational intervention was significantly effective in reducing food insecurity score (P<0.001).Conclusion:The findings demonstrated the beneficial role of nutritional education and the skills of resource management in modifying nutritional behaviors and improving food security in the study population.

Food Insecurity Among Older Adults: 10-Year National Trends and Associations with Diet Quality.

Food insecurity has emerged as a critical health issue for older adults. Food insecurity has been shown to disrupt healthy eating patterns, but these associations have not been widely studied among older adults. The objectives of the present study were to: (1) examine national trends in food insecurity across a 10-year period, and (2) evaluate the associations between food insecurity and multiple diet quality indices in a recent and nationally representative sample of adults aged 60 or older. Cross-sectional analysis of the 2007-2016 National Health and Nutrition Examination Surveys. Nationally representative sample of the United States. The analytic sample was comprised of 5,097 adults aged 60 or older, with household incomes at or below 300% of the federal poverty level. Household food security was measured using the 18-item US Household Food Security Survey Module. Diet was assessed using two 24-hour dietary recalls. Multivariate linear and logistic regression models examined the associations between household food security and three evidence-based diet quality indices, adjusting for sociodemographic and health characteristics. Across the 10-year period, food insecurity increased significantly from 5.5% to 12.4% among older adults; this increase was more pronounced among lower-income older adults. From the linear regression models, food insecurity was associated with lower scores on the Healthy Eating Index (β = -1.90, 95% confidence interval (CI) = -3.70, -0.09), the Alternate Healthy Eating Index-2010 (β = -1.47, 95% CI = -2.51, -0.44), and the Mediterranean Diet Score (β = -0.54, 95% CI = -1.06, -0.01) after multivariate adjustment. Further adjustment for the presence of chronic medical conditions did not attenuate these results. Food insecurity is associated with lower overall diet quality among older adults, supporting the need for clinical efforts to identify those at risk of food insecurity and public health efforts to alleviate food insecurity and promote healthy eating behaviors among older adults.

The Need for Investment in Rigorous Interventions to Improve Child Food Security

The Need for Investment in Rigorous Interventions to Improve Child Food Security

Association of Food Insecurity and Sarcopenia: The National Health and Nutrition Examination Surveys

Understanding the association between food insecurity and sarcopenia can inform policies that address healthcare disparities. We identified 2,965 subjects aged ≥60 years with grip strength and food security data from the National Health and Nutrition Examination Surveys 2011-14. Sarcopenia was defined using grip strength <26kg for men and <16kg for women, and food security with the 18-item US Household Food Security Survey. Logistic regression evaluated the association of food insecurity (referent = full security) with sarcopenia, adjusting for age, sex, marital status, race/ethnicity, education, body mass index, smoking, and comorbidities. Mean age (% female) was 76.6 (60.9%) and 68.9 years (53.4%) with and without sarcopenia, respectively. Sarcopenia prevalence was 8.4%. Rates of full food security were higher in those without sarcopenia (90% vs. 84.2%;p<0.001). Food insecurity was strongly associated with sarcopenia (OR 1.79 [1.18, 2.72]), suggesting a need for both longitudinal and interventional studies to target these disparities.

Emerging adults' intersecting experiences of food insecurity, unsafe neighbourhoods and discrimination during the coronavirus disease 2019 (COVID-19) outbreak.

To examine how food insecurity is related to emerging adults' food behaviours and experiences of neighbourhood safety and discrimination and to identify resources needed to support their health during the COVID-19 outbreak. Rapid response online survey. Participants completed the six-item US Household Food Security Survey Module, a brief measure of food insufficiency, and measures of food behaviours, neighbourhood safety and discrimination. Open-ended questions were used to assess changes in eating behaviours during COVID-19 and needed resources. C-EAT (COVID-19 Eating and Activity over Time) study invitations were sent by email and text message to a longitudinal cohort. A total of 218 emerging adults (mean age = 24·6 (sd 2·0) years, 70·2 % female) completed a survey in April-May 2020 during a stay-at-home order in Minnesota. The past year prevalence of food insecurity was 28·4 %. Among food-insecure respondents, 41·0 % reported both eating less and experiencing hunger due to lack of money in the past month. Food-insecure respondents were less likely than those who were food secure to have fruits/vegetables at home and more likely to have frequent fast-food restaurant meals, feel unsafe in their neighbourhood and experience discrimination during the stay-at-home order. Food-insecure adults reported changes including eating more food prepared at home, eating more take-out restaurant meals and purchasing more energy-dense snacks as a result of events related to COVID-19. Resources most needed to support their health included eligibility for more food assistance and relief funds. Food-insecure emerging adults experience many barriers to maintaining healthful eating patterns during COVID-19.

Fruit and Vegetable Healthy Eating Index Component Scores of Distributed Food Bags Were Positively Associated with Client Diet Scores in a Sample of Rural, Midwestern Food Pantries

BackgroundFood pantries have the potential to improve the quality of clients’ diets. ObjectiveThis study evaluated the relationship between the quality of the mix of foods in pantry inventories and client food bags (separately), as assessed by the Healthy Eating Index-2010 (HEI-2010), with client diet quality and how these relationships varied by food security status. DesignThis cross-sectional, secondary analysis used baseline data from the Voices for Food intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Foods available in pantry inventories and distributed in client food bags were recorded at one time point during baseline data collection. Participants and settingA convenience sample of adult food pantry clients (N = 575) from 24 rural, food pantries in the US Midwest was recruited from August to November 2014. Main outcome measuresPantry inventories, client food bags, and client diets were scored using the HEI-2010. Main outcomes were client HEI-2010 scores. Statistical analyses performedLinear regression models estimated associations between HEI-2010 total and component scores for pantry inventories and client food bags (in separate models) and the corresponding scores for client dietary intake. The interaction of client food security status, and potential pantry- and client-level confounders, was considered. ResultsClient food bag HEI-2010 scores were positively associated with client diet scores for total vegetables, greens and beans, and total fruit components, whereas pantry inventory HEI-2010 scores were negatively associated with client diet scores for total fruit, total protein foods, and seafood and plant proteins components. Client food bag whole-grains scores were more strongly associated with very low food secure compared with food secure client diet scores (all P values < 0.05). ConclusionsThe quality of client food bags, but not of pantry inventories, was positively associated with client diet quality in a rural sample in the US Midwest.

To dine in or not to dine in: A comparison of food selection and preparation behaviours in those with and without food security.

Issue addressedVulnerable populations are disproportionately affected by food insecurity, resulting in heightened risk of suboptimal dietary intake. Food insecure people appear to implement several coping strategies and dietary compromises to avoid hunger. Less explored in the literature is how these strategies impact consumption of food inside and outside of the home.MethodsAn online survey was completed by adults (n = 1292) residing in one of five Australian states. The questionnaire comprised of the six‐item US Household Food Security Survey Module, 12 socio‐demographic variables and 32 questions related to elements of food literacy.ResultsFood insecure respondents were more likely to frequent fast food vs (P = .002), takeaway (P < .001) and food courts (P < .001) than their food secure counterparts. Food secure respondents reported greater use of raw (P = .043) and fresh, pre‐prepared produce (P = .002) when cooking, whereas food insecure respondents were more likely to prepare food using only frozen, pre‐packaged products (P < .001). No significant differences were found between food security status and the enjoyment and social bonding derived from cooking.ConclusionsFood insecure respondents appeared to be accessing a poorer quality of food through greater consumption of takeaway and fast food. These dietary compromises are most likely related to perceived financial, time or cooking facility constraints and to a lesser extent food literacy skills.So what?This study highlights some of the health and social inequities apparent within food insecure populations. Food insecure households should be supported to access healthy fresh food and in‐home cooking practices. While a multi strategy approach is required, healthy food environment policy, particularly in disadvantaged areas, should be considered to guarantee that all Australians have dignified access to nutritious food.

Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV

Food insecurity (FI) contributes to HIV-related morbidity and mortality, but the mechanisms whereby FI negatively impacts HIV health are untested. We tested the hypothesis that FI leads to poor HIV clinical outcomes through nutritional, mental health, and behavioral paths. We analyzed data from Women's Interagency HIV Study (WIHS) among 1803 women living with HIV (WLWH) (8225 person-visits) collected from 2013 to 2015 biannually from nine sites across the United States participating in the WIHS. FI was measured with the US Household Food Security Survey Module. Outcomes included HIV viral nonsuppression, CD4 cell counts, and physical health status (PHS). We used longitudinal logistic and linear regression models with random effects to examine associations adjusting for covariates and path analysis to test nutritional, mental health, and behavioral paths. Increasing severity of FI was associated with unsuppressed viral load, lower CD4 counts, and worse PHS (all p < 0.05). Report of FI 6 months earlier was independently associated with most outcomes after adjusting for concurrent FI. For viral nonsuppression, the nutritional and behavioral paths accounted for 2.09% and 30.66% of the total effect, with the mental health path operating via serial mediation through the behavioral path. For CD4 count, the mental health and behavioral paths accounted for 15.21% and 17.0% of the total effect, respectively. For PHS, depressive symptoms accounted for 60.2% of the total effect. In conclusion, FI is associated with poor health among WLWH through different paths depending on the outcome. Interventions should target FI and its behavioral and mental health mechanisms to improve HIV outcomes.

Household Food Security and Infant Adiposity.

Food insecurity has been associated with obesity, but previous studies are inconsistent and few included infants. We examined associations between household food security and infant adiposity and assessed the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) as effect modifiers. We hypothesized that infants from food-insecure households would have greater adiposity, with attenuation by WIC and SNAP. We repeatedly measured 666 infants from the southeastern United States in 2013-2017. We categorized households as high, marginal, low, or very low using the US Household Food Security Survey Module. Outcomes were BMI z score, subscapular and triceps skinfold-for-age z score, the sum of subscapular and triceps skinfolds, the ratio of subscapular and triceps skinfolds, and BMI z score ≥1 (at risk for overweight). We used covariate-adjusted repeated-measures linear and logistic regressions. Of infants, 68.6% were Black and 60.5% had household incomes <$20 000. Interactions between food security and WIC and/or SNAP were not significant. Compared with infants from high food security households, infants from very low food security households had higher BMI z scores (0.18 U; 95% confidence interval [CI] 0.01 to 0.35), higher subscapular skinfold-for-age z scores (0.31 U; 95% CI 0.04 to 0.59), a higher sum of subscapular and triceps skinfolds (0.53 mm; 95% CI 0.002 to 1.07), and greater odds of being at risk for overweight (odds ratio 1.55; 95% CI 1.14 to 2.10). Infants from low food security households had greater odds of being at risk for overweight (odds ratio 1.72; 95% CI 1.17 to 2.10). In larger and longer studies, researchers should examine food security and adiposity in young children.

Food insecurity among graduate students: prevalence and association with depression, anxiety and stress.

The impact of food insecurity on mental health has not yet been examined in graduate students, a population widely considered at elevated risk for financial strain and negative mental health outcomes. This study aimed to derive initial prevalence estimates of food insecurity in a sample of current graduate students at a large state university and to elucidate the relationship between food insecurity and depression, anxiety and stress in this sample. Cross-sectional online survey including the US Household Food Security Survey Module: Six-Item Short Form and the Depression, Anxiety, and Stress Scales (DASS-21). University in the northeastern region of the USA. Two hundred sixty-three graduate students. In the present sample, 59·7 % of participants reported high/marginal food security, 18·5 % reported low food security and 21·8 % reported very low food security. Graduate students with very low food security reported significantly greater depression (η2 = 0·09), anxiety (η2 = 0·10) and stress (η2 = 0·10), compared with those with low food security and high food security (all P's < 0·001). Food insecurity occurred in nearly half of the graduate students surveyed, and very low food security was associated with elevated levels of depression, anxiety and stress. Findings highlight the need to address food insecurity and associated elevated mental health problems present among graduate students.

Diet Quality and Associations with Food Security among Women Eligible for Indiana Supplemental Nutrition Assistance Program-Education

The diet quality among adults receiving nutrition education lessons through Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is currently unknown. The objectives of this study were to characterize the diet quality of Indiana SNAP-Ed-eligible women; estimate their mean usual intake of fruits, vegetables, dairy, and whole grains compared to Dietary Guidelines for Americans (DGA) recommendations; and determine if these dietary outcomes differed by food security status. SNAP-Ed paraprofessionals recruited participants from August 2015 to May 2016 for this secondary analysis of cross-sectional data collected as the baseline assessment for a randomized controlled trial. Participants were SNAP-Ed-eligible women aged ≥18 y interested in nutrition education lessons. Dietary outcomes were assessed by one or two 24-h dietary recalls. The Healthy Eating Index (HEI)-2010 was used to characterize diet quality. Mean usual intake of food groups was estimated using the National Cancer Institute Method. Food security status was classified using the US Household Food Security Survey Module. Data were analyzed in October 2019. Mean±SEM HEI-2010 total score was 42±0.9 for the study sample. Mean±SE usual intake of servings of fruits (0.61±0.08 cups [144.32 ± 18.93 mL]), vegetables [1.4±0.10 cups (331.2 ± 23.66 mL)], dairy [1.5±0.11 cups (354.88 ± 26.02 mL)], and whole grains [0.48±0.06 ounces (13.61 ± 1.70 g)] did not differ by food security subgroup. Mean HEI-2010 total score was significantly higher by 4.8±2.0 points for the food-secure than for the food-insecure subgroup (P=0.01). Mean HEI-2010 component scores were 1.1±0.5 points higher for whole grain (P=0.01) and 1.0±0.5 points higher for dairy (P=0.05) in the food-secure than in the food-insecure subgroup. The proportions of the study sample not meeting the DGA recommendations for food group intake were ≥85% for both food-secure and -insecure subgroups. Indiana SNAP-Ed-eligible women reported poor diet quality, highlighting their need for nutrition interventions aiming to improve food security and diet as per DGA recommendations in low-income populations.

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

Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers’ self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.

Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural, Midwestern Food Pantry Clients

BackgroundFood pantry users represent a predominantly food insecure population, yet dietary intake may differ among food secure (FS), low FS, and very low FS clients. Usual intake of food groups and nutrients by food security status has not previously been compared among food pantry clients. ObjectiveThis study aimed to estimate the usual intakes of underconsumed nutrients (ie, potassium; dietary fiber; choline; magnesium; calcium; vitamins A, D, E, and C; and iron) and related food groups (ie, vegetables, fruits, whole grains, and dairy) and dietary quality, and to evaluate their relationship with food security status. DesignThis cross-sectional, secondary analysis used baseline data from a prior intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Participants/settingThis community-based study included a convenience sample of adult, midwestern food pantry clients (N=579) recruited from August to November 2014. Main outcome measuresMain outcomes evaluated were Healthy Eating Index-2010 scores and usual intakes of underconsumed nutrients and related food groups. Statistical analyses performedLinear regression models and the National Cancer Institute method, adjusting for confounders, were used to estimate associations of food security with diet quality and usual intake, respectively. ResultsBeing FS was associated with a higher whole grains HEI-2010 score and higher mean usual intake of whole grains compared with being low FS. Being FS was associated with higher usual intakes of iron and dairy compared with being very low FS. Being FS was associated with a higher mean usual intake of dark green vegetables compared with being low FS and very low FS. Usual intakes were below federal guidance for all subgroups of food security. ConclusionsAlthough food security status may differentiate dietary intake among food pantry clients, improvements are needed among all clients.

Assessing Food Insecurity in Medical Students.

Food insecurity, defined as the lack of reliable access to sufficient quantities of affordable, nutritious food and present in 11.1% of the general population, has not been assessed in medical students. Food insecurity is related to adverse outcomes for both health and academics in undergraduate students. Assessing the presence of food insecurity in medical students, a population at high risk for burnout and depression, may allow for intervention in order to improve overall wellness in this population. The objectives of this study were to assess the prevalence of food insecurity in a medical student population and identify potential reasons for any measured food insecurity. We used a questionnaire that included the US Household Food Security Survey Module: Six-Item Short Form. The survey was emailed to all students enrolled at a Northeastern medical school (N=588) to assess food insecurity in the previous 3 months. The questionnaire included potential reasons for food insecurity. The survey response rate was 22.4%. Food insecurity was present in 11.8% of these respondents. The main reasons selected for food insecurity were not being able to get to the store (33.9%), followed by insufficient funds (30.4%). Prevalence of food insecurity in medical students may be similar to the general population. While the results of this study represent only one medical school, we believe these results are similar at other medical schools. Interventions to reduce food insecurity in this population are necessary to improve overall student wellness.

Food Insecurity is Associated with Autonomic Dysfunction Among Latinos with Type 2 Diabetes

Abstract Objectives Food insecurity (FI) is higher among Latinos than non-Hispanic Whites and associated with risk for type 2 diabetes (T2D). Autonomic nervous system (ANS) dysfunction increases mortality in diabetes. We examined FI and ANS function among Latinos with T2D. Methods Participants were drawn from the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial. Inclusion: age 18 years, Latino or Hispanic, Spanish speaking, ambulatory status, T2D 6 months, A1c &amp;gt; 7.0%. Exclusion: medical or psychiatric instability; pain or dysfunction in hands precluding handgrip testing. Measures: FI was assessed with the 6-item US household food security survey module; affirmative responses to &amp;gt; = 1 questions was coded as FI. Six autonomic measures were scored 0 = normal or 1 = abnormal based on published cutoffs and then summed for a total ANS dysfunction index. ANS measures and their normal cutoffs were: 1) metanephrine &amp;lt;350 ug/day; 2) normetanephrine &amp;lt;600 ug/day; 3) cortisol 50–190 ug/day, all from 24-hour urine specimens; 4) 24-hour heart rate variability as reflected in standard deviation of the normal-to-normal (SDNN) heart rate acquired with 3-channel, 7-lead ambulatory electrocardiogram (holter) monitors, 149 +/–39; 5) difference between the highest diastolic blood pressure (DBP) during sustained handgrip and the average DBP at rest, &amp;gt;15 mmHg; and, 6) difference between baseline supine and the minimal BP after standing up, normal = decline in SBP &amp;lt;=20 mmHg and DBP &amp;lt;=10 mmHg. Results N = 35 participated, n = 23 (65.7%) were women, age M = 61.6 (SD = 11.2) years, A1c M = 8.5% (SD = 1.6) and n = 20 (57.1%) used insulin. N = 22 (62.9%) reported FI and n = 25 (71.4%) had at least one abnormal ANS measure. In t-tests, participants with FI had a higher ANS dysfunction index (M = 1.5, SD = 0.9) than patients who were food secure (M = 0.7, SD = 0.8), P = 0.02). Total autonomic index was not related to A1c or insulin use. Conclusions In this Latino sample with T2D, FI was associated with greater ANS dysfunction. Increasing food security may confer autonomic benefits. Funding Sources Supported by National Institute on Minority Health and Health Disparities grant R01MD005879 and American Diabetes Association grant 7–13-TS-31.

College Student Perceptions and Utilization of Food and Nutrition Resources on Campus: Study Protocol

Abstract Objectives Food and nutrition are important to college student success and well being, yet little work has been done to characterize food and nutrition environments on college campuses regarding how students utilize food and nutrition resources, barriers and facilitators to accessing and consuming a healthy diet, and what students value in a campus food system, such as sustainability. The objective of this pilot study is to characterize the food and nutrition environment on the University of Alaska Anchorage (UAA) campus, specifically by: Measuring the prevalence of food insecurity on the UAA campus Determining barriers and facilitators to accessing and consuming a healthy diet on campus Analyzing the relationship between food insecurity and indicators of student success and health Assessing the importance of sustainable campus food systems to UAA students Methods Phase 1: Focus Groups. Students utilizing a free meal service at UAA (the Daily Den) will be recruited to participate in one of two focus groups (target sample size n = 20) to explore how students use the food and nutrition services on campus, barriers and facilitators they experience in accessing and consuming a healthy diet, and what they value in a campus food system. Grounded theory will be used to determine common themes and guide the development of survey questions. Phase 2: Survey. A survey will be administered to a convenience sample of Daily Den clients (target sample size n = 60) to collect information on demographics, indicators of student success (i.e., GPA), indicators of health (i.e., BMI), the US Household Food Security Survey, and questions determined from Phase 1. Survey data will be analyzed to determine the prevalence of food insecurity on campus, the barriers/facilitators to accessing and consuming a healthy diet, and how each may be associated with indicators of student success and health. Importance of sustainable food systems to students will also be assessed. Results N/A (study protocol) Conclusions Understanding how college students perceive and utilize food and nutrition services available to them on campus will provide valuable insight into addressing food insecurity and sustainability on college campuses. Results from this study will be used to inform the future of food and nutrition services at UAA. Funding Sources None.

Household food insecurity: associations with disordered eating behaviours and overweight in a population-based sample of adolescents.

To examine how household food insecurity is related to adolescent weight status and disordered eating. Cross-sectional, population-based study. Adolescents self-reported unhealthy weight control behaviours, binge eating and meal frequency; weight status was measured. Household food insecurity was assessed by asking parents to respond to the validated six-item US Household Food Security Survey Module. Adolescents surveyed within Minneapolis/St. Paul public middle and high schools completed surveys at school, and their parents/guardians were surveyed by mail during the 2009-2010 academic year. Ethnically/racially diverse, primarily low-income adolescents (mean age: 14·4 years, range: 10-22 years) and their parents/guardians (n 2285 dyads). More than one-third (38·9 %) of the adolescents experienced past-year household food insecurity, 43·2 % reported disordered eating and 39·6 % were overweight. Generalised regression models showed that food insecure (FI) compared with food secure (FS) adolescents had higher prevalence of overweight (FI: 42·3 % v. FS: 37·9 %, P = 0·039), lower breakfast consumption (FI: 4·1 times/week v. FS: 4·4 times/week, P = 0·005) and greater use of unhealthy weight control behaviours (FI: 49·0 % v. FS: 39·5 %, P < 0·001) in unadjusted models. Models adjusted for parental education, ethnicity/race, sex and age found that food insecurity was associated with higher prevalence of unhealthy weight control behaviours (FI: 44·5 % v. FS: 37·8 %, P = 0·007), but not with weight status or other eating behaviours. These results suggest that food insecurity may be an independent risk factor for unhealthy weight control behaviours, indicating a need to approach these intersecting issues in a comprehensive manner.