The household food insecurity access scale and an index-member dietary diversity score contribute valid and complementary information on household food insecurity in an urban West-African setting

The number of urban poor is increasing quickly in West Africa, yet food security early warning systems still do not include urban areas. One reason is the lack of appropriate and internationally agreed-upon indicators to measure urban household food insecurity. Our objective was to assess the performance of the household food insecurity access scale (HFIAS) and an index-member's dietary diversity score (IDDS) to approximate the adequacy of urban households' diets. A survey was performed on a random cluster sample of 1056 households in Ouagadougou, Burkina Faso. Data on HFIAS and IDDS and 2 nonconsecutive household quantitative 24-h recalls were collected twice, in June-July and in November-December 2007. Diet adequacy was assessed through the household's mean adequacy ratio (MAR) using energy and 11 micronutrients. Structural equation modeling was used to quantify the association of each candidate indicator with the MAR and receiver-operating characteristic (ROC) analyses were performed to assess their targeting performance in predicting low or high MAR. HFIAS was negatively associated with the MAR [path coefficient (P) = -7.95 × 10(-3) ± 1.45 × 10(-3); P < 0.001], whereas IDDS was positively associated with it (P = 5.19 × 10(-2) ± 1.27 × 10(-2); P < 0.001). Areas under the ROC curves ranged from 0.585 to 0.661 for HFIAS and from 0.536 to 0.629 for IDDS. In conclusion, HFIAS and IDDS performed well in approximating adequacy of urban households' diets. They are informative indicators about urban food insecurity, promising for evaluation and monitoring but not for household targeting given their insufficient predictive power.     

Vulnerability to Food Insecurity in Urban Slums: Experiences from Nairobi,Kenya

Food and nutrition security is critical for economic development due to the role of nutrition in healthy growth and human capital development. Slum residents, already grossly affected by chronic poverty, are highly vulnerable to different forms of shocks, including those arising from political instability. This study describes the food security situation among slum residents in Nairobi, with specific focus on vulnerability associated with the 2007/2008 postelection crisis in Kenya. The study from which the data is drawn was nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which follows about 70,000 individuals from close to 30,000 households in two slums in Nairobi, Kenya. The study triangulates data from qualitative and quantitative sources. It uses qualitative data from 10 focus group discussions with community members and 12 key-informant interviews with community opinion leaders conducted in November 2010, and quantitative data involving about 3,000 households randomly sampled from the NUHDSS database in three rounds of data collection between March 2011 and January 2012. Food security was defined using the Household Food Insecurity Access Scale (HFIAS) criteria. The study found high prevalence of food insecurity; 85 % of the households were food insecure, with 50 % being severely food insecure. Factors associated with food security include level of income, source of livelihood, household size, dependence ratio; illness, perceived insecurity and slum of residence. The qualitative narratives highlighted household vulnerability to food insecurity as commonplace but critical during times of crisis. Respondents indicated that residents in the slums generally eat for bare survival, with little concern for quality. The narratives described heightened vulnerability during the 2007/2008 postelection violence in Kenya in the perception of slum residents. Prices of staple foods like maize flour doubled and simultaneously household purchasing power was eroded due to worsened unemployment situation. The use of negative coping strategies to address food insecurity such as reducing the number of meals, reducing food variety and quality, scavenging, and eating street foods was prevalent. In conclusion, this study describes the deeply intertwined nature of chronic poverty and acute crisis, and the subsequent high levels of food insecurity in urban slum settings. Households are extremely vulnerable to food insecurity; the situation worsening during periods of crisis in the perception of slum residents, engendering frequent use of negative coping strategies. Effective response to addressing vulnerability to household food insecurity among the urban poor should focus on both the underlying vulnerabilities of households due to chronic poverty and added impacts of acute crises.     

Measuring household food insecurity: why it's so important and yet so difficult to do

Food insecurity is a daily reality for hundreds of millions of people around the world. Although its most extreme manifestations are often obvious, many other households facing constraints in their access to food are less identifiable. Operational agencies lack a method for differentiating households at varying degrees of food insecurity in order to target and evaluate their interventions. This chapter provides an overview of a set of papers associated with a research initiative that seeks to identify more precise, yet simple, measures of household food insecurity. The overview highlights three main conceptual developments associated with practical approaches to measuring constraints in access to food: 1) a shift from using measures of food availability and utilization to measuring "inadequate access"; 2) a shift from a focus on objective to subjective measures; and 3) a growing emphasis on fundamental measurement as opposed to reliance on distal, proxy measures. Further research is needed regarding 1) how well measures of household food insecurity designed for chronically food-insecure contexts capture the processes leading to, and experience of, acute food insecurity, 2) the impact of short-term shocks, such as major floods or earthquake, on household behaviors that determine responses to food security questions, 3) better measurement of the interaction between severity and frequency of household food insecurity behaviors, and 4) the determination of whether an individual's response to survey questions can be representative of the food insecurity experiences of all members of the household.     

The 2008 food price crisis negatively affected household food security and dietary diversity in urban burkina faso

Although the 2008 food price crisis presumably plunged millions of households into poverty and food insecurity, the real impact of the crisis has rarely been documented using field data. Our objective was to assess the consequences of this crisis for household food insecurity and dietary diversity in urban Burkina Faso. Two cross-sectional surveys were conducted among randomly selected households in Ouagadougou in July 2007 (n = 3017) and July 2008 (n = 3002). At each round, food insecurity assessed by the Household Food Insecurity Access Scale (HFIAS), the Dietary Diversity Score of an index-member of the household (IDDS = number of food groups consumed in the last 24 h), and food expenditure were collected. Food prices of the 17 most frequently consumed food items were recorded throughout the study area. Food prices at local markets increased considerably between 2007 and 2008, especially those of fish (113%), cereals (53%), and vegetable oil (44%), increasing the household monthly food expenditure by 18%. Thirty-three percent of households were food secure in 2007 and 22% in 2008 (P = 0.02). Individuals consumed fewer fruits and vegetables, dairy products, and meat/poultry in 2008 than in 2007 (mean IDDS = 5.7 ± 1.7 food groups in 2007 vs. 5.2 ± 1.5 in 2008; P < 0.0001). Differences in IDDS and HFIAS between the 2 y were even more marked after adjustment for confounding factors and food expenditure. Food security and dietary diversity significantly decreased between 2007 and 2008, whereas food prices increased. Households increased their food expenditure, but this was not sufficient to compensate the effects of the crisis.     

The School Breakfast Program strengthens household food security among low-income households with elementary school children

The School Breakfast Program is an important component of the nutritional safety net and has been linked to positive changes in meal patterns and nutritional outcomes. By offering a breakfast, which for low-income children is available either at no cost or reduced price, the program also has the potential to increase household food security. This study examined the relationship between availability of the School Breakfast Program and household food security among low-income third-grade students by using data from the Early Childhood Longitudinal Survey-Kindergarten Cohort. The primary sample included 3010 students. Availability of school breakfast was assessed by surveys of school administrators. Food security was assessed by parents' reports by using the standard 18-item food security scale and considering 2 different food security thresholds. A probit model was estimated to measure the relationship between school breakfast availability and household food security while controlling for a range of other characteristics. Access to school breakfast reduced the risk of marginal food insecurity but not the risk of food insecurity at the standard threshold. That is, the program appeared beneficial in offsetting food-related concerns among at-risk families, although not necessarily in alleviating food insecurity once hardships had crossed the food insecurity threshold. Increasing the availability of school breakfast may be an effective strategy to maintain food security among low-income households with elementary school children.     

Paternal smoking is associated with greater food insecurity among poor families in rural Indonesia

Food insecurity is common in developing countries and related to the physical well being of families. Household food insecurity is intended to reflect a household's access, availability, and utilization of food. The relationship between paternal smoking and household food insecurity has not been well characterized. The objective of this study was to examine the relationship of paternal smoking with household food insecurity among poor families in rural Indonesia. In a cross-sectional study of 26,380 rural households in the Indonesian Nutrition Surveillance System in 2003, we examined the relationship between paternal smoking and household food insecurity score, as measured using a 9-item food security questionnaire. The prevalence of paternal smoking was 72.9%. In families with and without a father who smoked, the mean (standard error) household food insecurity score was 1.83 (0.01) and 1.48 (0.02), respectively (p<0.0001). Paternal smoking was associated with greater household food insecurity score (p<0.0001) in a multivariable linear regression model, adjusting for maternal age, maternal education, weekly household expenditure per capita, and province. Among poor families in rural Indonesia, households with a father who smokes are at greater risk of household food insecurity.     

Food insecurity: a nutritional outcome or a predictor variable?

The phenomenon loosely labeled hunger in the 1980s is now being discussed as food security or insecurity. Food security is defined as access by all people at all times to enough food for an active, healthy life, and at a minimum includes the following: 1) the ready availability of nutritionally adequate and safe foods and 2) the assured ability to acquire personally acceptable foods in a socially acceptable way. Food insecurity exists whenever food security is limited or uncertain. The measurement of food insecurity at the household or individual level involves the measurement of those quantitative, qualitative, psychological and social or normative constructs that are central to the experience of food insecurity, qualified by their involuntariness and periodicity. Risk factors for food insecurity include any factors that affect household resources and the proportion of those resources available for food acquisition. Potential consequences of food insecurity include hunger, malnutrition and (either directly or indirectly) negative effects on health and quality of life. The precise relationships between food insecurity and its risk factors and potential consequences need much more research now that there is an emerging consensus on the definition and measurement of food insecurity. Indicators of food security or insecurity are proposed as a necessary component of the core measures of the nutritional state of individuals, communities or nations.     

Country of birth is associated with very low food security among Mexican American older adults living in colonias along the south Texas border with Mexico

The availability of an adequate household food supply is critical for the older population. There is little work that has examined food security and the influence of nativity on food security among older Mexican Americans living along the Texas-Mexico border. Using data from 140 older women (age ≥ 50 y) who participated in the 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA), we examined demographic characteristics, health characteristics, food access and mobility, federal and community food and nutrition assistance programs, quality of food environment, food security, eating behaviors, and alternative food sources. 77% of participants experienced food insecurity, with 68% experiencing very low food security. Very low food security was associated with being born in Mexico, adjusting for household income and food assistance program participation. This article provides compelling evidence for enhanced research efforts that will better understand coping strategies and the use of food and nutrition assistance programs for reducing hardship associated with very low food security among older U.S.- and Mexico-born Mexican American women.     

Development and validation of an experience-based measure of household food insecurity within and across seasons in northern Burkina Faso

Organizations measure household food insecurity for program design, planning, targeting, implementation, monitoring, and evaluation, but existing measures often are inadequate. Qualitative and quantitative methods were used to develop and validate an experienced-based measure of the access component of food insecurity in northern Burkina Faso. In-depth interviews on food insecurity were done with 10 household heads and 26 women using interview guides. We identified themes, classified households, created a table of food insecurity categories, identified items to add to or delete from an initial questionnaire, and developed and revised answer choices. A longitudinal study provided quantitative data on changes over time in household food insecurity, economic situation, and related factors. Data were collected on 126 simple and complex households from 9 villages each July and January from 2001 to 2003 (5 waves). These data allowed examination of changes in household food insecurity twice annually across the best and worst seasons for food, and evaluation of the ability of the experience-based measure to differentiate changes in household food insecurity. Validity was assessed by examining reliability and by comparing the experienced-based food insecurity measure with economic status, dietary, and anthropometric measures and with a measure created by an observer who rated the households' food insecurity. The results provide strong evidence that the food insecurity score, calculated from experience-based questionnaire items, was valid for determining seasonal differences in household food insecurity, differences among households in food insecurity at a given time, and changes in household food insecurity over time in northern rural Burkina Faso.     

Household food access and child malnutrition: results from the eight-country MAL-ED study

Background

Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites.

Methods

We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites.

Results

Average age of study children was 41 months. Mean food access insecurity score (range: 0–27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p?=?0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p?=?0.17).

Conclusions

Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

     

Predictors and outcomes of household food insecurity among inner city families with preschool children in Vancouver

OBJECTIVES: The purposes of this study were to measure household food security and to determine its association with potential predictor variables related to household and community environments, as well as the relationship between household food insecurity and preschool children's nutritional status. METHODS: In this cross-sectional study, household food security was measured in a convenience sample of households (n=142) with children aged 2-5 years in Vancouver in March 2004. We assessed the association between environmental predictors and household food security status, adjusted for household income. Indicators of children's nutrition were compared between categories of household food security. RESULTS: Household food insecurity was associated with indicators of suboptimal health status in preschoolers. After controlling for household income, parents with less access to food of reasonable quality, fewer kitchen appliances and a lower rating of their cooking skills had greater odds of experiencing household food insecurity. IMPLICATIONS: Our study results support the need to test interventions involving collaborative efforts among government, social planners and public health practitioners to remove barriers to food security for families. Multiple measures, including opportunities to gain practical food skills and household resources that enable convenient preparation of nutrient-dense foods, could be examined. Our findings suggest the need for improved selection and quality at existing small stores and an increase in the number of food outlets in low-income neighbourhoods.     

Coping strategies and nutrition education needs among food pantry users

In response to unexpectedly high rates of household food insecurity in Washington State, focus groups were conducted with food pantry users in nine locations across the state to explore access and barriers to food, strategies for coping with food insecurity, and nutrition education needs. All respondents had children and spoke English. Participants reported household food insecurity and concerns about feeding children and getting through the month. Stretching food dollars was the most requested topic for nutrition education. Nutrition educators need to be responsive to people's educational needs and the emotional demands associated with food insecurity at the program and community levels.     

A Community-Based Survey of Household Food Insecurity and Associated Sociodemographic Factors among 2–6 Years Old Children in the Southeast of Iran

Malnutrition remains a major public health issue in developing and transitional countries and food insecurity is a major indicator of the nutritional status in these societies. This research aimed to investigate the status of household food insecurity and sociodemographic factors affecting it among 2–6 years old children in an urban area in the southeast of Iran. A community-based survey was conducted from September to January 2018 on 421 children aged 2–6 years who were selected using stratified cluster random sampling. They lived in six different areas in an urban area in the southeast of Iran. Data was collected using the U.S. Department of Agriculture Food Security questionnaire and anthropometric measurements. Our study showed that the prevalence of food insecurity among children was 81.7% consisting of 2.6% with low food security, 9.2% with moderate food insecurity, and 69.9% with very low food security. The weight gain of those children who were in the low food security group, was 2.63 times lower than those children in the food security group. Moreover, the chance of weight gain in the low food security and in the moderate food insecurity groups was less as 1.91 and 1.41 times, respectively. Food insecurity in children aged 2–6 years is influenced by various sociodemographic factors including weight and height, mother’s education level, sanitation as access to water closet (WC). Policymakers should plan to improve the quality of life and health of the children through improving their food security.     

Food Security and Perceptions of Health Status: A Preliminary Study in Rural Appalachia

Food insecurity is estimated to affect about 10% of the United States population. Rural areas experience even higher rates and intensity of food security problems related to poverty, food access, and higher food costs. Reports of the relationship between household food security and health status, however, are limited. This report examines the relationship between household food security and measures of functional health status in a rural Appalachian sample. A comprehensive health status survey was completed by 1,006 individuals seen either in a clinical (n = 605) or nonclinical (n = 401) community setting. The survey included the USDA Food Security Core Module, the SF-36, and demographic and health care access questions. Household food insecurity was reported by 23% of respondents. Food insecure respondents reported significantly poorerfunctional status on all SF-36 scales compared tofood secure respondents (all p < 0.05). After adjusting for demographic and access variables in a multiple regression analysis, food insecurity remained a significant independent predictor of responses for each SF-36 scale. Generalizability of results are limited by the convenience sampling methods and geographic region in which the study was conducted. In this preliminary study, even minimal levels of food insecurity are related to self-reported levels of health status as measured by the SF-36 spectrum. Health professionals must be able to identify individuals at risk for food insufficiency; policy makers must develop more effective programs for alleviating the basic causes of food insecurity.     

Commonalities in the experience of household food insecurity across cultures: what are measures missing?

This paper hypothesizes that there is a common "core" to the household food insecurity experience that goes beyond insufficient food quantity and that transcends culture. The paper for the first time employs an exploratory approach to identify cross-cultural commonalities of the food insecurity experience as captured in 22 scales and related ethnographies derived from 15 different countries. The constant comparative method was used to code elements of the food insecurity experience expressed in the ethnographies and to regroup them into domains and subdomains. This typology was then applied to ascertain which experiential domains and subdomains were measured (or not) across all 22 studies. Survey data from 11 of the studies were then analyzed to assess similarities in the relative frequency with which culturally diverse households responded to questionnaire items related to these common domains/subdomains. The analysis confirmed that insufficient food quantity, inadequate food quality, and uncertainty and worry about food were a significant part of the food insecurity experience in all sampled cultures; concerns about social unacceptability emerged in all ethnographic accounts. Several subdomains were identified, such as concern over food safety and meal pattern disruption, with potentially important consequences for physical and psychological well-being. The comparative survey data showed that the relative frequency at which populations responded to domain-related questionnaire items was similar across all but a few cultures. Future food insecurity assessments should consider these core domains and subdomains as the starting point for measures that can generate rich information to inform food security policies and programs.     

Statewide prevalences of concern about enough food, 1996-1999

OBJECTIVE: Food insecurity is defined as not having access at all times to enough food for an active and healthy life-style. A Healthy People 2010 objective is to increase food security and reduce the risk of hunger for all households. The objective of this study was to characterize the prevalence of concern about enough food and its association with other sociodemographic and health characteristics at the state level. METHODS: Adult respondents participating in the Behavioral Risk Factor Surveillance System survey provided information on concern about enough food from nine states from 1996 through 1999. RESULTS: Overall, the prevalence of concern about enough food ranged from 3.1% to 11.8% for individual states. Across states, low household income was the strongest predictor of concern about enough food. The odds of being concerned about enough food were generally higher among respondents who were female, younger, and without health care coverage. The odds were generally lower among those reporting excellent or very good general health and among non-Hispanic whites. CONCLUSION: Food security scales could be used at the state level to track progress for the Healthy People 2010 objective of reducing food insecurity and hunger across American households.     

Household food insecurity was prevalent in Java during Indonesia's economic crisis

Valid assessment of household food security is important, particularly in rapidly changing circumstances such as the economic crisis that struck Indonesia in 1998. The Cornell-Radimer tool for measuring household food security has now been used in several social and economic settings. An adaptation of this tool was used in the context of the economic crisis of Java, Indonesia in June-August 1998 in a survey of 1423 mothers with children < 5 y old. Qualitative and quantitative data contributed to understanding food insecurity and provided evidence for some aspects of validity. The data showed substantial household food insecurity with 94.2% of households found to be uncertain or insecure about their food situation in the previous year. Of respondents, 11% reported losing weight in the previous year because of lack of food. Food security in Java was undoubtedly compromised by the economic crisis. These results suggest, on the basis of qualitative and quantitative understandings of food insecurity, that this tool provided a useful measure of the situation in Java in 1998. From this study and others done recently, such a tool or ones constructed using a similar approach have been found to be useful in various settings in which there is a need to understand and identify household food insecurity for purposes of estimating and monitoring prevalence and targeting of policies and programs. Further research to validate this approach in various settings is warranted.     

Food security measurement in cultural pluralism: Missing the point or conceptual misunderstanding?

ObjectiveFood Security has become a global concern, yet its measurement has varied considerably across disciplines and countries. We examined the current discrepancies in the definitions of food security and propose a framework for understanding and measuring food security.MethodsThis conceptual review draws from a range of works published in Medline and the gray literature to advance the understanding of food security concepts. We begin by examining the historical background of food security and then move on to examine its various definitions and interpret food through cultural lenses in terms of food access and utilization. We finish by examining various measurements and indicators of food security and reviewing implications for public health.ResultsWe argue that the reliance on coping strategies as surrogate measurements of food insecurity without taking into account the social, cultural, and political contexts in which they occur is misleading, and viewing food insecurity solely from a food access or availability perspective, without taking into account food utilization and asset creation as pillars of food security, paints an incomplete picture. Although this review does not claim to provide solutions to the discrepancies in the conceptual definition of food security, it attempts to highlights areas of concern and provide a way forward.ConclusionWhen coping strategies are used as an indicator of food insecurity, they need to be culturally relevant and focus tested, and together with objective measurements of nutritional outcomes, would allow policy makers to make evidence-based decisions to inform social and nutrition policies.     

Understanding the experience of household food insecurity in rural Bangladesh leads to a measure different from that used in other countries

This research aimed to gain in-depth understanding of the experience of household food insecurity in rural Bangladesh and to develop a direct measure of it from this understanding. Using naturalistic, emergent inquiry, in-depth interviews were conducted with 21 rural women living in diverse situations using a semistructured interview guide. Two analytic strategies classified households on food insecurity and elicited themes that were the basis for classification. Survey questions were developed to capture themes, and were revised after review, field testing, and ranking and pile-sorting exercises. Four gradations of severity of food insecurity resulted, based on nine themes: meals, cooking, rice, fish, perishable foods, snacks, festival food, other expenditures and management strategies. The emergent conceptualization of food insecurity differs from that found from naturalistic research in other countries. The developed food insecurity measure has 11 questions. This research affirms the value of gaining in-depth understanding of household food insecurity. In many situations, this approach, rather than translating questions developed elsewhere, may best lead to suitable experience-based measures of food insecurity.     

Food security status of households in Appalachian Ohio with children in Head Start

This study measured food security and hunger of households involved in Head Start in a rural Appalachian county and assessed factors that could affect food security and hunger. A convenience sample of households with children enrolled in the Head Start program in Athens County, Ohio, were sampled (n=710), with adults from 297 (42%) households responding. The survey instrument included the 18-question US Household Food Security Survey Module for measuring hunger and food insecurity. Of those responding, 152 households (51.2%) were food secure and 145 (48.8%) were food insecure. Ninety (30.3%) had experienced hunger in the previous 12 months, and 41 (13.8%) households were classified as food insecure with childhood hunger. Hunger was related to a variety of household characteristics and associated with several factors, including participation in food banks, dependence on family members and friends outside of the household for food, lacking reliable transportation, and not having a garden.