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.     

Access to Healthful Foods among an Urban Food Insecure Population: Perceptions versus Reality

The influence of local food environments on the risk for obesity is important overall, but may be particularly important for food insecure populations in urban settings. Access to healthful foods is most limited among racial and ethnic minorities and low-income populations; these same populations experience the highest rates of obesity and food insecurity. Few valid and reliable measures have been developed to assess the quality of local food environments. This research addresses this gap by introducing an inventory for measuring self-reported perceptions of food access and then compares the perceptions measure to objective assessments of local food environments. Data are focused on an urban population experiencing disproportionate rates of food insecurity. The four-item perceptions of food access inventory had high internal consistency (Cronbach’s alpha = 0.80). Participants’ perceptions of access to healthful foods mirrored the reality of their food environment; however, perceptions of access to alcohol and tobacco were less accurate. Findings suggest that people living in low-income, urban, minority, and food insecure communities can validly assess (in)access to healthful foods. Future research is needed to further validate the perceptions of food access measure introduced and, more importantly, to develop strategies for increasing access to healthful foods in food insecure contexts.     

Culinary Nutrition Education Improves Home Food Availability and Psychosocial Factors Related to Healthy Meal Preparation Among Children

ObjectiveTo evaluate the effectiveness of a culinary nutrition education intervention on children's home food availability and psychosocial factors related to healthy meal preparation.DesignRandomized-controlled trial.SettingSchools in Kuala Lumpur, Malaysia.ParticipantsEighty-three school children aged 10–11 years and their parents.InterventionTwelve weeks of culinary nutrition education with 5 hands-on healthy meal preparation modules and a module with parents on home food availability (conducted every 2 weeks).Main Outcome MeasuresPsychosocial factors (knowledge, attitude, practice, and self-efficacy) related to healthy meal preparation and home food availability (fruits, vegetables, healthful foods, and less healthful foods) assessed via children and parents, respectively, using validated questionnaires at baseline, postintervention, and 3-month follow-up.AnalysisRepeated measures ANOVA.ResultsIntervention group had a higher (P < 0.001) mean knowledge score (mean difference, 1.2), attitude (mean difference, 2.6), practice (mean difference, 4.4) and self-efficacy (mean difference, 3.9) of healthy meal preparation as compared with control group across 3-time points. Improvements were seen in the availability of fruits (mean difference, 3.0; P < 0.001), vegetables (mean difference, 2.4; P < 0.001), healthful foods (mean difference, 1.5; P < 0.001) and less healthful foods (mean difference, ?0.9; P = 0.001), favoring the intervention group.Conclusion and ImplicationsCulinary nutrition education had positive impact on children's psychosocial factors and home food availability, demonstrating the potential to improve children's nutrition.     

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.     

Validation of a Home Food Environment Instrument Assessing Household Food Patterning and Quality

The home food environment (HFE) is associated with dietary intake; yet measuring HFE quality often requires burdensome collection of detailed inventories. This project evaluated the capacity of the Home Inventory to Describe Eating and Activity, version 2 (Home-IDEA2) to capture HFE quality by measuring the presence or absence of household foods. Validity was tested using a modified application of the Healthy Eating Index-2010 (HEI). Comparative data were drawn from the National Food Acquisition and Purchase Survey (FoodAPS) Food-at-Home Public Use File. HEI scores were calculated for 4202 households in FoodAPS using Home-IDEA2 inventories and full reported inventories. Paired t-tests compared: (1) estimated vs. total edible grams (EEG; TEG); (2) limited vs. all reported foods; and (3) EEG + limited foods vs. TEG + all reported foods. Sensitivity and range of scores were compared. Mean HEI scores for Home-IDEA2 were higher (p < 0.003) than FoodAPS: (1) 51.6 ± 16.1 vs. 49.6 ± 18.1 (food amounts); (2) 53.5 ± 15.8 vs. 49.8 ± 15.4 (food items); (3) 55.5 ± 15.7 vs. 49.8 ± 15.4 (full instrument); differences were small. Scores demonstrated comparable sensitivity and range. The study found that the Home-IDEA2 can capture HFE quality adequately with low data collection burden.     

Food Cravings,Ethnicity and Other Factors Related to Eating Out

Objective: Our objective was to study factors related to eating patterns, specifically whether certain food cravings were associated with frequency of meals eaten away from home.

Methods: Data were collected from 277 patients from a family medicine residency office in Arizona. The survey questionnaire included information about the respondents’ demographics, socioeconomic status, food cravings, as well as, number of meals eaten away from home. The food craving inventory included foods in four categories identified by factor analysis: fast foods, carbohydrates, sweets and snacks. Data on food cravings were factor analyzed and scale scores were derived.

Results: Being a Hispanic adult, working outside the home, and cravings for individual food items were related to eating more meals away from home. If the mother was working outside the home, the youngest child ate an average of two additional meals away from home each week. In general respondent’s cravings for some specific food items were also related to higher numbers of meals their child ate away from home. Cravings for both fast food and snacks were positively correlated with adult eating out. None of the respondents’ scale scores were related to child’s eating away from home. Adults with Arizona Health Care Cost Containment System insurance (AHCCCS—a form of Medicaid) and older adults were less likely to eat away from home compared to patients with other types of insurance.

Conclusions: Socioeconomic status, ethnicity, and food cravings are related to adult and child patterns of eating meals away from home.     

The Association Between Food Insecurity and Dietary Outcomes in University Students: A Systematic Review

BackgroundUniversity students may experience a high prevalence of food insecurity. The impacts of food insecurity on dietary intake and meal patterns of students have not been fully researched.ObjectiveThis systematic review aimed to examine the association between food insecurity and dietary outcomes among university students.MethodsNine electronic databases and gray literature were searched from their inception to July 2020. Studies that reported dietary outcomes in both food-secure and -insecure students or the association between food insecurity and dietary outcomes among current students in tertiary education settings in any country were included. All study designs were eligible for inclusion, except qualitative studies. Two reviewers completed the screening, data extraction, and quality assessment independently. Study quality was assessed using the Joanna Briggs Institute appraisal tools.ResultsSixteen studies were included in the final qualitative synthesis of this review. Most studies were cross-sectional designs and of fair quality. The prevalence of food insecurity among university students ranged from 21% to 82% across studies. Lower intakes of healthy foods (eg, fruits, vegetables, and whole grains) and higher intakes of unhealthy foods (eg, fast foods, added sugars, and sugar-sweetened beverages) were observed in food-insecure students, and studies with the most representative samples of the student body found these trends. Some food-insecure students consumed breakfast and evening meals less frequently than food-secure students but the evidence was limited. Validated food security and dietary assessment tools were inconsistently used to assess diet quality among students with differing food security status. The heterogeneity of student sampling and data collection may contribute to inconsistent findings.ConclusionPoorer dietary outcomes were found in university students with food insecurity compared with food-secure students, but statistical significance was only observed in a small number of studies. Future longitudinal studies using food security and dietary assessment tools validated in this population are recommended to confirm the observed associations between food insecurity and diet quality among university students.     

Assessing the Food Availability and Food Insecurity Situation among Communities of Matam Region,Senegal

ABSTRACT

Matam is one of the poorest and most food-insecure regions of Senegal. In the past years, repeated environmental shocks such as drought have limited the access to food and it is unclear whether food insecurity is more a function of food availability (FA) and accessibility at the community level (CL) or more related to FA at the household level (HL). To better understand the FA and food security (FS) situation in this region, in 2018, a cross-sectional study was conducted in 103 households living in four villages. Through focus group discussions and direct observations, data on food available at HL and CL were collected as well as on food affordability and household FS. Overall, between 49 and 64 different foods, mostly from plant source, were identified. Around 75% of households had 0 to 3 foods and 7%, 7 to 10; 64% of all households were severely food insecure. FA at HL and its socioeconomic status were positively associated with household FS whereas FA at the CL was negatively associated. Although food assistance may be required to respond to shocks in the area, investments could be made to improve households` socioeconomic level to enhance their access to food.     

The Use of Charitable Food Assistance Among Low-Income Households in the United States

BackgroundAbout 11% of US households are food insecure, and many of those households seek charitable food assistance (CFA). However, little is understood about the nutritional composition of the diets of households receiving CFA, or the relationship between CFA and Supplemental Nutrition Assistance Program (SNAP) usage among low-income households.ObjectiveThe aim of the study was to compare the nutritional quality of foods obtained by CFA clients to those of similar nonclients. Furthermore, the study examined the timing of CFA use relative to the timing of SNAP use among CFA clients during the week.Design/participantsAnalyses were conducted using 2012 US Department of Agriculture National Household Food Acquisition and Purchase Survey (FoodAPS), which collected data for 4826 households’ food acquisitions during a 7-day survey week. Sixty-seven households reported using CFAs during the survey week.Main outcomes measureThe nutritional quality of food was measured by the ratios between food acquisition quantities and the US Department of Agriculture Thrifty Food Plan consumption recommendations. The date of SNAP use was compared with that of CFA use for CFA clients who were also SNAP recipients.Statistical analyses performedPropensity score matching was utilized to construct a matching sample of CFA clients and nonclients. T tests were used to compare the means of variables.ResultsCFA clients were more likely to be food insecure (48% vs 28%, P < .001) and less likely to have access to a car (61.2% vs 84.8%, P < .001) than CFA nonclients. CFAs represent an important source of foods for CFA clients, taking up 28% of their total food at home acquisitions. CFA clients obtained more nonstarchy vegetables than matched nonclients. Furthermore, among the 45% of CFA clients who also participated in SNAP, the majority (52.4%) of them used SNAP benefits within 10 days of SNAP benefits distribution while most (67.9%) of those households used CFAs starting on day 11 or later after SNAP benefits were allocated.ConclusionsCFAs provide a substantial portion of the diets of their clients and, in particular, for foods that constitute components of healthy diets. For the proportion of CFA clients who received SNAP, this study finds evidence that CFA clients relied more on CFAs when their SNAP benefits were likely to run low.     

Increasing access to healthful foods: a qualitative study with residents of low-income communities

Background

Inadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members’ opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities.

Methods

Spanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods.

Results

A total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than $1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions.

Conclusion

The results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future.

     

Differences in Home Food and Activity Environments between Obese and Healthy Weight Families of Preschool Children

ObjectiveTo develop and test a home food and activity instrument to discriminate between the home environments of obese and healthy weight preschool children.DesignA modified questionnaire about home environments was tested as an observation tool.SettingFamily homes.ParticipantsA total of 35 obese children with at least 1 obese caregiver were compared with 47 healthy weight children with no obese caregivers.Main Outcome MeasuresHome observation assessments were conducted to evaluate the availability of devices supporting activity behaviors and foods based on availability, accessibility, and readiness to be eaten.AnalysisAgreement statistics were conducted to analyze psychometrics and MANOVAs were conducted to assess group differences, significance, P < .05.ResultsHome observations showed acceptable agreement statistics between independent coders across food and activity items. Families of obese preschoolers were significantly less likely to have fresh vegetables available or accessible in the home, were more likely to have a television in the obese child's bedroom, and had fewer physical activity devices compared with healthy weight preschoolers.Conclusions and ImplicationsFamilies of young children live in home environments that were discriminatively characterized based on home observations. Future tool refinement will further clarify the impact of the home environment on early growth.     

Differences in Food Environment Perceptions and Spatial Attributes of Food Shopping Between Residents of Low and High Food Access Areas

ObjectiveTo explore potential differences in food shopping behaviors and healthy food availability perceptions between residents living in areas with low and high food access.DesignA cross-sectional telephone survey to assess food shopping behaviors and perceptions. Data from an 8-county food environment field census used to define the Centers for Disease Control and Prevention (CDC) healthier food retail tract and US Department of Agriculture Economic Research Service food desert measure.ParticipantsA total of 968 residents in 8 South Carolina counties.Main Outcome MeasuresResidents' food shopping behaviors and healthy food availability perceptions.AnalysisLinear and logistic regression.ResultsCompared with residents in high food access areas, residents in low food access areas traveled farther to their primary food store (US Department of Agriculture Economic Research Service: 8.8 vs 7.1 miles, P = .03; CDC: 9.2 vs 6.1 miles, P < .001), accumulated more total shopping miles per week (CDC: 28.0 vs 15.4 miles; P < .001), and showed differences in perceived healthy food availability (P < .001) and shopping access (P < .001).Conclusions and ImplicationsThese findings lend support to ongoing community and policy interventions aimed at reducing food access disparities.     

Abstracts of Articles on Nutrition and Bone Loss

Objective: To identify if particular foods or food groups may be associated with obesity in children and adolescents and to determine if consuming food away from home (FAFH) has an effect on the nutritional quality of their diets.

Design: One-year cross-sectional study.

Setting/Subjects: The obese subjects (n = 91) were on the waiting list for a hospital-based weight control treatment program. The non-obese subjects (n = 90) were recruited from community advertisements.

Measures of Outcome: Information on food intake was obtained using the dietary history method by a Registered Dietitian. Body fat was determined by bioelectrical impedance analysis.

Results: Obese children and adolescents consumed significantly more servings of meat and alternatives, grain products, FAFH, sugar-sweetened drinks and potato chips which contributed to a higher calorie, fat and sugar intake compared to non-obese children and adolescents. Sugar-sweetened drinks were only significantly greater in boys. The consumption of meat servings, sugar-sweetened drinks and FAFH was positively correlated with percent body fat. The frequency of food consumed outside of the Canada’s Food Guide To Healthy Eating was not different between the two groups.

Conclusions: Obese children and adolescents need to limit their access to food consumed away from home and sugar-sweetened drinks as there is a relationship between these foods and body fatness.     

Ethnic Differences in the Home Food Environment and Parental Food Practices Among Families of Low-Income Hispanic and African-American Preschoolers

The family and home environment are important in shaping the dietary patterns of children, yet research among low-income, minority groups is limited. We examined ethnic differences in the home food environment and parental practices among 706 low-income, African-American and Hispanic families of preschoolers. Questionnaires measured the access and availability of various foods in the home, parental practices, and meal consumption behaviors. Mixed model logistic regression and ANCOVA were used to assess ethnic differences. Unhealthy foods were available for both groups. Hispanic families were more likely to have fresh vegetables (AOR?=?2.9, P?≤?0.001), fruit (AOR?=?2.0, P?=?0.004), and soda available (AOR?=?1.40, P?=?0.001) compared to African-Americans. African-Americans families were more likely to restrict (AOR?=?0.63, P?≤?0.001) and reward with dessert (AOR?=?0.69, P?≤?0.001). Hispanic families consumed more family meals together (P?=?0.003) and less meals in front of the television (P?≤?0.006). Health promotion interventions should consider the behavioral differences between ethnicities.     

Regional Food Consumption in the Northeast of Brazil by the Low-Income Population

Brazilian foods have been influenced by many cultures, colonizers, slaves, and native indians. Tracing the regional foods is important to analyze diets and discuss food culture. Objective: to evaluate the frequency and variety of regional foods consumed by Brazilians from the Northeast, users of a government program. Methods: This exploratory study analyzed food intake of low-income customers eating in community restaurants. 753 individuals participated, representing a sampling error smaller than 3.5% for national representativeness. The 24HR was used at the restaurants on two weekdays and one weekend day. Results Customers consumed 47 different regional preparations. The prefered ones were cuscuz, baião dois, and tapioca. Food intake was higher at dinner. An average of 1.3 regional preparations were consumed, for each 10 preparations. Conclusion: The mean consumption of regional foods was low. It may reveal higher intakes of ready-to-eat. Even this population does not take the time to prepare regional foods.     

High Food Insecurity and Its Correlates Among Families Living on a Rural American Indian Reservation

Objectives. We sought to better understand the prevalence and consequences of food insecurity among American Indian families with young children.Methods. Parents or caregivers of kindergarten-age children enrolled in the Bright Start study (dyad n = 432) living on the Pine Ridge Reservation in South Dakota completed a questionnaire on their child’s dietary intake, the home food environment, and food security. We assessed food security with a standard 6-item scale and examined associations of food insecurity with family sociodemographic characteristics, parents’ and children’s weight, children’s dietary patterns, and the home food environment.Results. Almost 40% of families reported experiencing food insecurity. Children from food-insecure households were more likely to eat some less healthful types of foods, including items purchased at convenience stores (P = .002), and food-insecure parents reported experiencing many barriers to accessing healthful food. Food security status was not associated with differences in home food availability or children’s or parents’ weight status.Conclusions. Food insecurity is prevalent among families living on the Pine Ridge Reservation. Increasing reservation access to food that is high quality, reasonably priced, and healthful should be a public health goal.Food insecurity is defined as the state of either having limited or uncertain access to food that is nutritionally adequate, culturally acceptable, and safe or having an uncertain ability to acquire acceptable foods in socially acceptable ways.1 Food insecurity harms children’s physical, social, and emotional health. Compared with food-secure children, children who experience food insecurity are less likely to have a diet that meets recommended guidelines for nutrition2–4; are more likely to experience chronic illnesses, acute illness,5,6 psychosocial problems, and psychiatric distress5,7–9; and are more likely to have lower academic performance.10 There is some evidence to suggest that food insecurity contributes to overeating and obesity,11–13 although several studies of preschool– and grade school–aged children have not observed associations between food insecurity and weight status.2,12,14,15 The roots of food insecurity for a family often lie in economic factors, such as having insufficient income, limited wealth, excessive debt, and high living expenses. However, psychosocial factors, including maternal mental and physical health status, domestic violence, parental cooking and financial skills, parental education level, and familial social networks, also play roles in food insecurity.7,16 Additionally, lack of access to food in their community increases families’ likelihood of being food insecure.16 Nationwide in 2009, 21.3% of US households with children experienced food insecurity during the previous year.17Since the middle of the twentieth century, substantial changes have occurred in the availability of and access to healthful food on American Indian reservations.18,19 Although, traditionally, American Indian populations used the land they lived on for hunting and growing food, and therefore consumed a plant-based diet supplemented with fish or low-fat meat, today this is no longer the case.20 American Indians living on reservations often rely on food–commodity and nutrition assistance programs21,22 and frequently purchase food from fast-food outlets and small grocery or convenience stores, which typically have a limited availability of high-quality produce and low-fat foods.19Given the high rates of poverty23 on American Indian reservations and poor food access on rural reservations, food insecurity and its health impacts among American Indian families living on or near reservations are of great concern.24,25 Using data from the 2001–2004 Current Population Survey, Gundersen examined food insecurity among American Indians living on and those living off reservations and found that during this period 28% of American Indian households with children experienced food insecurity, compared with 16% of non–American Indian households with children.24 This disparity remained even after adjusting for education, income, marital status, and age, suggesting that American Indians had additional specific risk factors for food insecurity. Furthermore, American Indians living in nonmetropolitan areas were more likely to be food insecure than were those living in metropolitan areas—although identifying those individuals specifically residing on or near reservations was not possible with this data set. Small, reservation-specific studies have examined food insecurity among selected groups of American Indians living on reservations, such as young adults, and have similarly observed that food insecurity is a prevalent and significant problem for these subpopulations.26–28Although it is clear that a sizable proportion of American Indians experience food insecurity, the correlates and consequences of food insecurity among American Indian families of young children living on or near reservations are not well understood. To address this need, we examined the prevalence and correlates of food insecurity among Lakota children and their families living on the Pine Ridge Reservation in South Dakota.