Geographic patterns and socioeconomic differences in the nutritional quality of household packaged food purchases in the United States

BackgroundIt is unclear whether dietary quality varies by geography in the US.PurposeAssess patterns in packaged food purchases (PFPs).MethodsWe characterized variation in PFP quality from 2008 to 2018 by 1) examining geographic clustering and 2) using regression analysis to control for household characteristics.ResultsLower quality purchases clustered in the Southeast and Appalachia, whereas higher quality purchases clustered in the West and Northeast. Spatial patterns were similar for low socioeconomic households but not high socioeconomic households. Geographic differences in quality remained after controlling for demographic composition.ConclusionThis analysis should inform research into systemic drivers of PFP quality.     

The Contribution of Major Food Categories and Companies to Household Purchases of Added Sugar in Australia

BackgroundThe Australian Government will soon be releasing a series of sugar reformulation targets for packaged foods.ObjectiveTo estimate the amount of added sugar purchased from packaged food and beverages and the relative contribution that food categories and food companies made to these purchases in 2018. The secondary objective was to examine differences in purchases of added sugar across income levels.DesignCross-sectional study.Participants/settingWe used 1 year of grocery purchase data from a nationally representative panel of Australian households (the NielsenIQ Homescan panel), combined with a packaged food and beverage database (FoodSwitch).Main outcome measuresAdded sugar purchases (grams per day per capita), purchase-weighted added sugar content (grams per 100 g) and total weight of products (with added sugar) purchased (grams per day per capita).Statistical analyses performedFood categories and food companies were ranked according to their contribution to added sugar purchases. Differences in added sugar purchases by income levels were assessed by 1-factor analysis of variance.ResultsAdded sugar information was available from 7188 households and across 26,291 unique foods and beverages. On average, the amount of added sugar acquired from packaged foods and beverages was (mean ± SE) 35.9 ± 0.01 g/d per capita. Low-income households purchased 11.0 g/d (95% CI: 10.9-11.0 g/d, P < .001) more added sugar from packaged products than high-income households per capita. The top 10 food categories accounted for 82.2% of added sugar purchased, largely due to purchases of chocolate and sweets, soft drinks, and ice cream and edible ices. Out of 994 food companies, the top 10 companies contributed to 62.1% of added sugar purchases.ConclusionsThe Australian Government can strengthen their proposed sugar reduction program by adding further category-specific targets, prioritizing engagement with key food companies and considering a broader range of policies to reduce added sugar intakes across the Australian population.     

Nutrition in agricultural development: Intensive dairy farming by rural smallholders

This study concerns the introduction of intensive dairy farming among rural smallholders in Kilifi District, Kenya. Household surveys were conducted among dairy farmers, dairy customers and a comparison sample from rural locations. Dairy farmers were better off than the rural sample as regards household income, food production, food consumption and nutritional status of young children. These differences resulted from the dairy activities but also from greater involvement in crop cultivation and off‐farm employment.

Local milk purchases by dairy customers were mostly by wealthier households with wage employment. They had higher incomes and higher food consumption than the rural sample, and the children in these households had better nutritional status. Further analysis confirms a positive relation between milk consumption and nutritional status of children, independent of household income, energy intake and level of education. Other notable findings were the high incomes from off‐farm employment of dairy farmers; regular dairy customers are chiefly households with wage employment; milk consumption among the rural population was very low.

The results cast doubt on the importance of intensive dairy production as a means of livelihood for resource‐poor households and the importance of milk as a means to improve nutritional status of children in low‐income households.     

Disrupted Relationships,Chaos, and Altered Family Meals in Food-Insecure Households: Experiences of Caregivers and Children

BackgroundRegular family meals foster healthy physical and social development of children but often occur less frequently in households experiencing food insecurity. How food insecurity influences the quality of these interactions is not understood well.ObjectiveTo better understand family meal experiences of caregivers and children living in food-insecure households.DesignA qualitative method with cross-sectional sample was used, collecting data using semistructured interview guides.ParticipantsTwenty ethnically diverse caregiver–child (aged 9 to 15 years) dyads in South Carolina were interviewed.Statistical analysisData were analyzed using grounded theory in Nvivo 10.ResultsFood-insecure households described family meals that varied in frequency, location, and quality of foods served, especially during times of food shortages. Interpersonal relationships drove the quality of mealtime interactions for these households. Household chaos not only influenced the frequency and location of meals, but also strained mealtime interactions in households with poor interpersonal relationships. In these homes, household chaos included conflicts with work and afterschool schedules, food shortages, coping with poverty and food insecurity (eg, working extra hours or seeking food assistance), and children visiting multiple homes, particularly when food was limited. All households experienced chaos, but strong interpersonal relationships were described as the primary reason for enjoyable mealtime experiences with few disruptions.ConclusionsExploring family meal experiences of children in food-insecure households highlights the importance of interpersonal relationships and regular, positive mealtime interactions that may strengthen emotional connections in families to improve child health outcomes.     

Perceived Access and Actual Intake of Healthy Diets Among Households in Vulnerable Salvadoran Communities

ObjectiveThis study aimed to examine the dietary intake of Salvadoran households according to perceived access to healthy meals (PAHD), and to identify household characteristics associated with diet quality and PAHD.MethodsSecondary data analysis with a sample of 139 Salvadoran households from resource-poor communities in El Salvador. Chi-square tests and ANOVA were used to assess differences in dietary intake across households classified according to PAHD.ResultsHigh-PAHD households had higher women's education, household food security levels, overall diet quality, and variety, and higher intakes of animal products, fats, cholesterol, vitamin C, and sodium (P < .05). Diet quality was not associated with the household characteristics studied.Conclusions and ImplicationsOverall diet quality was associated with higher levels of PAHD, but some differences in intakes were not as expected, such as higher intakes in foods and nutrients associated with low-quality diets, among high PAHD households.     

Few Changes in Food Security and Dietary Intake From Short-term Participation in the Supplemental Nutrition Assistance Program Among Low-income Massachusetts Adults

ObjectiveTo examine whether short-term participation in the Supplemental Nutrition Assistance Program (SNAP) affects food security and dietary quality among low-income adults recruited from a Massachusetts-wide emergency food hotline.MethodsA 3-month, longitudinal study was conducted among 107 adults recruited at the time of SNAP application assistance. Outcomes included household food security (10-item US Department of Agriculture Food Security Survey Module), dietary intake (eg, grains, fruit) and diet quality (modified Alternate Healthy Eating Index). Data were analyzed using paired t tests and multivariable linear regression.ResultsSupplemental Nutrition Assistance Program participation was not associated with improved household food security over 3 months (P = .25). Compared with non-participants, SNAP participants increased refined grain intake by 1.1 serving/d (P = .02), from baseline to follow-up. No associations were observed with other foods, nutrients, or dietary quality.Conclusion and ImplicationsPolicies that simultaneously improve household food security and dietary quality should be implemented to support the health of low-income Americans participating in this crucial program.     

Examining effects of food insecurity and food choices on health outcomes in households in poverty

Evidence documenting effects of food assistance programs, household food insecurity, and nutrition knowledge on health outcomes is building. Using data from a sub-sample of adults who are 185% of the poverty line from the 2007–2008 National Health and Nutrition Examination Survey (N = 2,171), we examine whether household food insecurity, food stamp take-up, and use of informal food supports are associated with health risk among low-income households. Findings indicate that while nutrition knowledge provides protection against health risk in food secure households, the health benefits of nutrition knowledge were not evident in food insecure households. We discuss these findings in light of current policy and practice interventions that recognize the importance of providing healthy, affordable food options for food insecure households.     

Household food security status and its associated factors in Baft-Kerman,IRAN: a cross-sectional study

ABSTRACT

Food insecurity is prevalent in both developed and developing countries, which has considerable health impacts on the social, physical, and psychological status. This study aimed to examine the food security status and its related sociodemographic factors among the households living in Baft city of Iran. A sample of 702 households was selected by a simple random sampling method from January to March 2017. Using U.S. Department of Agriculture Food Security questionnaire, 34.3% of households showed some degree of food insecurity. Lower household size (OR = 0.84, CI: 0.73–0.97, P = .02), higher welfare facilities (OR = 1.55, CI: 1.32–1.81, P < .001), educational levels of the mothers and their spouse (being diploma as compared to under-diploma) (OR = 1.57, CI: 0.98–2.53, P = .04 and OR = 1.65, CI: 1.05–2.57, P = .02), governmental employment as compared to unemployment of the spouse (OR = 1.85, CI: 1.14–2.99, P = .01), and house ownership (rent compared to owner house; OR = 0.41, CI: 0.21–0.81, P = .01) were significantly associated with food security. The findings showed food insecurity was associated with some sociodemographic factors among households in Baft. These findings demonstrate that the government needs to continue its efforts to provide appropriate funding for population-based programs and policies, to enhance food security of the people living in this city.     

GROWTH STATUS OF CHILDREN IN NORTH WEST SYRIA: A COMPARISON OF THREE RURAL LIVELIHOOD GROUPS

Studies linking agricultural development with food consumption and nutrition have concentrated on cash cropping and on the effects of changes in income. This paper uses models drawn from Farming Systems and the new household economics to examine economic and demographic factors affecting diet and food consumption for progressive farmers in Swaziland. Production factors are more closely linked to food consumption than to nutritional status of either women or children. In general, hybrid maize production is positively associated with consumption and cotton production is negatively associated. More mature households with fewer preschool children have higher consumption levels. Women's time use and opportunities for off‐farm employment may be important variables mediating nutritional status of women and children in rural Swazi households.     

Socio-economic and age variations in response to supermarket-led checkout food policies: a repeated measures analysis

Background

Dietary inequalities between population groups are common with older and more affluent individuals tending to have healthier diets. Differential responses to health interventions may exacerbate inequalities. Changing what foods are displayed at supermarket checkouts is one intervention that has the potential to change diets. The aim of this study was to assess whether differences in purchases of common checkout foods from supermarkets with different checkout food policies varied according to age group and social grade.

Methods

We analysed annual household purchase data for 2013–17 from nine leading UK supermarkets, split according to age of the main household shopper and household social grade. Checkout food policies were categorised as clear and consistent, vague or inconsistent, and none. Policies were heterogeneous but all included removal of confectionery and/or chocolate from checkouts. Mixed effects linear regression models were used to assess differences in purchases of common checkout foods (sugary confectionery, chocolate and potato crisps) by checkout food policy and whether these varied by age group or occupational social grade.

Results

Relative to supermarkets with no checkout food policy, 14% (95% CI: 4–22%) fewer purchases of common checkout foods per household per percentage market share were made in supermarkets with a clear and consistent policy. Adjusted mean numbers of purchases were higher in older age groups than the youngest, but there were no differences between the highest and other social grades. There were significant interactions between checkout food policy and both age group and social grade. In supermarkets with clear and consistent policies, 23% (6–36%), 20% (2–34%), and 23% (7–37%) fewer purchases were made in age groups 45–54, 55–64 and 65+ years respectively, compared to all groups combined. In supermarkets with clear and consistent policies, there were 21% (4–35%), 26% (9–39%) and 21% (3–35%) fewer purchases made by households in the highest two and lowest social grades respectively, compared to all groups combined.

Conclusions

Households with older main shoppers and those in the most and least affluent social grades may be most responsive to supermarket checkout food policies. As older and more affluent groups tend to have healthier diets overall, it is unlikely that supermarket checkout food policies contribute to greater dietary equity.

     

Women's Health Policies Associated with Obesity,Diabetes, High Blood Pressure,and Smoking: A Follow-Up on the Women's Health Report Card

ABSTRACT

This study sought to elucidate associations between state-level policies related to women's health and state prevalence of obesity, smoking, high blood pressure, and diabetes among women. Using data from national sources compiled for Making the Grade on Women's Health: A National and State-by-State Report Card, state policies on key women's health issues were evaluated on the degree to which policies adequately protected women's health. Blocked regressions assessed the policies associated with state outcomes. Anti-discrimination policies were prominent for high blood pressure, smoking, and obesity; models accounted for significant variance for all outcomes. State policies that support women may improve women's health.     

Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity,Food Insecurity,and Depression

BackgroundUnderstanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs.ObjectiveTo examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults.DesignThe cross-sectional study was conducted from February 2017 to May 2017.Participants/settingA total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated.Main outcome measuresParticipants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form).Statistical analyses performedGeneralized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications.ResultsLower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04).ConclusionsStudy results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.     

Food Insufficiency in the Households of Reproductive-Age Ecuadorian Women: Association with Food and Nutritional Status Indicators

Data from a nationally representative survey of Ecuadorian households with reproductive-aged women (n = 10,784) were used to analyze the prevalence of household food insufficiency (HFI) and its association with sociodemographic characteristics, food acquisition and expenditure patterns, dietary diversity, and anthropometric indicators. Fifteen percent of households had food insufficiency and 15% had marginal food sufficiency. HFI was associated with poverty-linked indicators. Marginally food sufficient households reported social and economic capital than food which appeared protective against HFI. Food insufficiency was associated with reduced household acquisition/expenditures on high quality protein and micronutrient-rich food sources. HFI was not associated with adult or adolescent female overweight/obesity but was associated with short adult stature (< 1.45 m). The ongoing nutrition transition in Ecuador is expected to continue to modify population food security, diet, and nutrition. Systematic surveillance of household level food security is needed to inform recent food-related policies and programs implemented by the Ecuadorian government.     

State Policies Targeting Alcohol Use during Pregnancy and Alcohol Use among Pregnant Women 1985–2016: Evidence from the Behavioral Risk Factor Surveillance System

BackgroundMost states have at least one policy targeting alcohol use during pregnancy. The public health impact of these policies has not been examined. We sought to examine the relationship between state-level policies targeting alcohol use during pregnancy and alcohol use among pregnant women.MethodsData include state-level alcohol and pregnancy policy data and individual-level U.S. Behavioral Risk Factor Surveillance System data about pregnant women's alcohol use from 1985 to 2016 (N = 57,194). Supportive policies include mandatory warning signs, priority substance abuse treatment, reporting requirements for data and treatment purposes, and prohibitions on criminal prosecution. Punitive policies include civil commitment, Child Protective Services reporting requirements, and child abuse/neglect. Analyses include logistic regression models that adjust for individual- and state-level controls, include fixed effects for state and year, account for clustering by state, and weight by probability of selection.ResultsRelative to having no policies, supportive policy environments were associated with more any drinking, but not binge or heavy drinking. Of individual supportive policies, only the following relationships were statistically significant: mandatory warning signs was associated with lower odds of binge drinking, and priority treatment for pregnant women and women with children was associated with higher odds of any drinking. Relative to no policies, punitive policy environments were also associated with more drinking, but not with binge or heavy drinking. Of individual punitive policies, only child abuse/neglect was associated with lower odds of binge and heavy drinking. Mixed policy environments were not associated with any alcohol outcome.ConclusionsMost policies targeting alcohol use during pregnancy do not seem to be associated with less alcohol consumption during pregnancy.     

Does the Timing of Food Stamp Distribution Matter? A Panel‐Data Analysis of Monthly Purchasing Patterns of US Households

In this paper, we examine the relationship between the timing of food stamp receipt and purchasing patterns. We combine data on state distribution dates of food stamps with scanner data on a panel of households purchases tracked between 2004 and 2011. We find that purchases of a variety of goods are meaningfully higher on receipt days, consistent with previous work that suggests that recipients are very impatient. Additionally, and importantly, estimates indicate that when food stamp receipt days fall on weekends, total monthly purchases within the same households are affected. In particular, monthly purchases of beer are higher when food stamps are distributed on a weekend rather than in months where benefits are distributed on weekdays. For these households, total beer purchases are between 4 and 5% higher in those months. Among households ineligible for food stamps, no effect is identified. These results demonstrate that the ‘day‐of‐the‐week’ of SNAP treatment may have important impacts on household purchase habits. Copyright © 2016 John Wiley & Sons, Ltd.     

Association of Food Insecurity and Food Addiction Symptoms: A Secondary Analysis of Two Samples of Low-Income Female Adults

BackgroundHousehold food insecurity persists in the United States and has important implications for health and well-being. Food insecurity in female-identified caregivers is particularly concerning, given its association with their mental health and adverse health outcomes for their children. Food insecurity is associated with disordered eating but, to our knowledge, no prior studies have examined an association between food insecurity and food addiction.ObjectiveOur aim was to examine whether food insecurity is associated with higher food addiction symptom endorsement in low-income female adults.DesignSecondary analysis of baseline data from a quasi-experimental study of a mindfulness-based intervention on gestational weight gain among low-income pregnant individuals and an observational study of low-income families.Participants/settingParticipants in study 1 (n = 208) were English-speaking, low-income pregnant individuals with overweight or obesity, recruited in California from 2011 to 2013. Participants in study 2 (n = 181) were English-speaking, low-income female caregivers for children aged 8 through 10 years, recruited in Michigan from 2018 to 2019. Both studies recruited participants from community health clinics, social service agencies, and online advertisements.Main outcome measuresThe primary outcome measure was food addiction symptoms, assessed by the Yale Food Addiction Scale.Statistical analysisMultivariate Poisson regression was used to examine the association between household food insecurity and food addiction symptoms in each sample, adjusted for sociodemographic characteristics.ResultsIn study 1, pregnant individuals in food-insecure households reported 21% higher food addiction symptoms than pregnant individuals in food-secure households (incidence rate ratio 1.21; 95% CI 1.00 to 1.47; P = .047). In study 2, caregivers in food-insecure households had 56% higher food addiction symptoms than caregivers in food-secure households (incidence rate ratio 1.56; 95% CI 1.01 to 2.40; P = .045).ConclusionsThese findings provide preliminary support for a relationship between household food insecurity and food addiction. Future research should examine potential mechanisms and whether interventions to reduce food insecurity lower risk of food addiction.     

Severity of household food insecurity and lifetime racial discrimination among African-American households in South Carolina

Objectives: In 2014, 30% of African-American households with children had low or very low food security, a rate double that of white households with children. A household has low food security if its members experience food shortages and reductions in food quality attributable to a lack of household resources or access and very low food security if its members also experience reductions in food intake and disrupted eating patterns. Households that are either low or very low food secure are known collectively as food insecure. We examined the association between the severity of household food insecurity and reports of lifetime racial discrimination among a sample of food-insecure African-American households in South Carolina.

Design: Data were collected from 154 African-American respondents. Food insecurity was measured using the US Department of Agriculture’s Household Food Security Survey Module. Lifetime racial discrimination was measured using the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV). We used logistic regression to test the association between severity of food insecurity (low vs. very low food secure), PEDQ-CV score and PEDQ-CV subscales. All models were adjusted for demographic and socioeconomic variables.

Results: A one-unit increase in the frequency of lifetime racial discrimination was associated with a 5% increase in the odds of being very low food secure (odds ratio (OR) 1.05, P?P?P?P?P?>?.05).

Conclusions: Severity of household food insecurity is associated with lifetime racial discrimination among African-American households in South Carolina.     

Relationships of Dietary Factors with Obesity,Hypertension, and Diabetes by Regional Type among Single-Person Households in Korea

This study aims to investigate whether dietary factors are differentially associated with metabolic abnormalities by regional type among single-person households in Korea. A total of 685,327 Korean adults aged ≥19 years who participated in the household and individual surveys of the Korea Community Health Survey 2015–2017 are included in the analysis. The regions are divided into three categories: metropolitan areas, mid-sized cities, and rural areas. Using multivariable logistic regressions, the adjusted odds ratios and 95% confidence intervals for metabolic abnormalities are estimated by regional type after adjusting for covariates. Among the total study population, 12.21% occupy single-person households, and 47.5%, 25.1%, and 27.4% of those single-person households are in rural areas, mid-sized cities, and metropolitan areas, respectively. Compared with single-person households in rural areas, those in mid-sized and metropolitan cities tend to be more familiar with and frequently refer to nutrition labels, skip breakfast, and experience food insecurity. Regional differences are found in the associations of dietary factors and behavior with obesity, hypertension, and diabetes. The use of nutritional fact labels is associated with obesity and hypertension in single-person households in rural areas, and the degree of association between food insecurity and diabetes is highest among single-person households in metropolitan areas. Our findings suggest that policies for improving unhealthy dietary factors by regional type are needed to reduce regional health disparities among single-person households in Korea.