Understanding Food Security as a Social Determinant of Diabetes-Related Health during Pregnancy

Gestational and pregestational diabetes during pregnancy are substantial and growing public health issues. Low-income individuals and individuals who identify as racial and ethnic minorities are disproportionately affected. Food security, which is defined as the degree to which individuals have capacity to access and obtain food, is at the center of nutritional resources and decisions for individuals with diabetes. While increasingly recognized as an important mediator of health disparities in the United States, food insecurity is understudied during pregnancy and specifically among pregnant individuals with diabetes, for whom the impact of food-related resources may be even greater. Previous research has suggested that food insecurity is associated with type 2 diabetes mellitus diagnoses and disease exacerbation in the general adult population. An emerging body of research has suggested that food insecurity during pregnancy is associated with gestational diabetes mellitus diagnoses and adverse diabetes-related outcomes. Additionally, food insecurity during pregnancy may be associated with adverse maternal and neonatal outcomes. Future research and clinical work should aim to further examine these relationships and subsequently develop evidence-based interventions to improve diabetes-related outcomes among pregnant individuals with food insecurity. The purpose of this article is to offer a working definition of food security, briefly review issues of food insecurity and diabetes, summarize research on food insecurity and diabetes-related pregnancy health, and discuss clinical recommendations and areas for future investigation. Key Points

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High food insecurity in Latinx families and associated COVID-19 infection in the Greater Bay Area, California

BMC Nutrition ◽

10.1186/s40795-021-00419-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Milagro Escobar ◽

Andrea DeCastro Mendez ◽

Maria Romero Encinas ◽

Sofia Villagomez ◽

Janet M. Wojcicki

Keyword(s):

Food Security ◽

Food Insecurity ◽

San Francisco ◽

Employment Status ◽

The United States ◽

Household Food Security ◽

Bay Area ◽

Household Food ◽

History Of ◽

The Impact

Abstract Background Food insecurity impacts nearly one-in-four Latinx households in the United States and has been exacerbated by the novel coronavirus or COVID-19 pandemic. Methods We examined the impact of COVID-19 on household and child food security in three preexisting, longitudinal, Latinx urban cohorts in the San Francisco Bay Area (N = 375 households, 1875 individuals). Households were initially recruited during pregnancy and postpartum at Zuckerberg San Francisco General Hospital (ZSFG) and UCSF Benioff prior to the COVID-19 pandemic. For this COVID-19 sub-study, participants responded to a 15-min telephonic interview. Participants answered 18 questions from the US Food Security Food Module (US HFSSM) and questions on types of food consumption, housing and employment status, and history of COVID-19 infection as per community or hospital-based testing. Food security and insecurity levels were compared with prior year metrics. Results We found low levels of household food security in Latinx families (by cohort: 29.2%; 34.2%; 60.0%) and child food security (56.9%, 54.1%, 78.0%) with differences between cohorts explained by self-reported levels of education and employment status. Food security levels were much lower than those reported previously in two cohorts where data had been recorded from prior years. Reported history of COVID-19 infection in households was 4.8% (95% Confidence Interval (CI); 1.5–14.3%); 7.2% (95%CI, 3.6–13.9%) and 3.5% (95%CI, 1.7–7.2%) by cohort and was associated with food insecurity in the two larger cohorts (p = 0.03; p = 0.01 respectively). Conclusions Latinx families in the Bay Area with children are experiencing a sharp rise in food insecurity levels during the COVID-19 epidemic. Food insecurity, similar to other indices of poverty, is associated with increased risk for COVID-19 infection. Comprehensive interventions are needed to address food insecurity in Latinx populations and further studies are needed to better assess independent associations between household food insecurity, poor nutritional health and risk of COVID-19 infection.

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Perceptions of the Food Environment and Access among Predominantly Black Low-Income Residents of Rural Louisiana Communities

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155340 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5340

Author(s):

Denise Holston ◽

Jessica Stroope ◽

Matthew Greene ◽

Bailey Houghtaling

Keyword(s):

Food Security ◽

Focus Group ◽

Food Insecurity ◽

Low Income ◽

Food Environment ◽

Food Access ◽

The United States ◽

Grocery Store ◽

Assistance Program ◽

Nutrition Assistance

Food insecurity in rural settings is complex and not fully understood, especially from the perspective of low-income and Black residents. The goal of this study was to use qualitative methods to better understand experiences with food access and perceptions of the food environment among low-income, predominately Black rural Louisiana residents in the United States. Data were collected from focus group discussions (FGD) and focus group intake forms. Study participants were all rural residents eligible to receive at least one nutrition assistance program. FGD questions focused on perceptions of the food environment, with an emphasis on food access. Participants (n = 44) were predominately Black and female. Over half (n = 25) reported running out of food before the end of the month. Major themes included: store choice, outshopping, methods of acquiring foods other than the grocery store, and food insecurity. Concerns around price, quality, and transportation emerged as factors negatively impacting food security. Understanding residents’ perceptions and experiences is necessary to inform contextually appropriate and feasible policy and practice interventions that address the physical environment and social conditions that shape the broader physical food environment in order to achieve equitable food access and food security.

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Accessibility of summer meals and the food insecurity of low-income households with children

Public Health Nutrition ◽

10.1017/s1368980016000033 ◽

2016 ◽

Vol 19 (11) ◽

pp. 2079-2089 ◽

Cited By ~ 11

Author(s):

Daniel P Miller

Keyword(s):

Food Security ◽

Food Insecurity ◽

Low Income ◽

Urban Areas ◽

California Health Interview Survey ◽

Lower Probability ◽

Geographic Accessibility ◽

Households With Children ◽

The Impact ◽

Low Income Households

AbstractObjectiveAlmost no previous research has examined the impact of the US Department of Agriculture’s (USDA) Summer Food Service Program and related Seamless Summer Option, which provide meals and snacks to low-income children over the summer. The present study investigated whether geographic accessibility of summer meals programme sites (a proxy for programme participation) was associated with food insecurity for low-income households.DesignThe study used data from the California Health Interview Survey (CHIS) and administrative data on summer meals sites in California. Geocoding was used to calculate driving time between CHIS households and nearby summer meals sites. Geographic accessibility was measured using a gravity model, which accounted for the spatially distributed supply of and demand for summer meals. Food insecurity and very low food security were measured using a standard six-item measure from the USDA.SubjectsLow-income families with children (n5394).SettingA representative surveillance study of non-institutionalized households in California.ResultsGeographic accessibility was not associated with food insecurity. However, geographic accessibility was associated with a significantly lower probability of very low food security in the full sample and among households with younger children and those living in less urban areas.ConclusionsThe USDA’s summer meals programme may be effective at reducing the most severe form of food insecurity for low-income households with children. Expanding the number of summer meals sites, the number of meals served at sites and sites’ hours of operation may be effective strategies to promote nutritional health over the summer months.

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Food Insecurity in a Low-Income, Predominantly African American Cohort Following the COVID-19 Pandemic

American Journal of Public Health ◽

10.2105/ajph.2020.306041 ◽

2021 ◽

Vol 111 (3) ◽

pp. 494-497

Author(s):

Tamara Dubowitz ◽

Madhumita Ghosh Dastidar ◽

Wendy M. Troxel ◽

Robin Beckman ◽

Alvin Nugroho ◽

...

Keyword(s):

African American ◽

Food Insecurity ◽

Low Income ◽

The United States ◽

Supplemental Nutrition Assistance Program ◽

Food Bank ◽

Assistance Program ◽

Nutrition Assistance ◽

National Trends ◽

The Impact

Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods. Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitudinal cohort (n = 605) previously followed from 2011 to 2018. We examined longitudinal trends in food insecurity from 2011 to 2020 and compared them with national trends. We also assessed use of food assistance in our sample in 2018 versus 2020. Results. From 2018 to 2020, food insecurity increased from 20.7% to 36.9% (t = 7.63; P < .001) after steady declines since 2011. As a result of COVID-19, the United States has experienced a 60% increase in food insecurity, whereas this sample showed a nearly 80% increase, widening a preexisting disparity. Participation in the Supplemental Nutrition Assistance Program (52.2%) and food bank use (35.9%) did not change significantly during the early weeks of the pandemic. Conclusions. Longitudinal data highlight profound inequities that have been exacerbated by COVID-19. Existing policies appear inadequate to address the widening gap.

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Food Insecurity and Mental Health Outcomes among Low Income, Minority Cohorts during the COVID-19 Pandemic

Proceedings of IMPRS ◽

10.18060/25947 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Sai Kodukula ◽

Amy Han

Keyword(s):

Mental Health ◽

Food Security ◽

Health Outcomes ◽

Food Insecurity ◽

Low Income ◽

Mental Health Outcomes ◽

Anecdotal Evidence ◽

Increased Risk ◽

Anxiety Depression ◽

The Impact

Objective: To examine the impact of the COVID-19 shutdowns on food insecurity and mental health outcomes among low income, minority communities in Northwest Indiana. Methods: Surveys were distributed to 160 households during the Northwest Indiana food bank distribution hours to assess food security mental health status. The survey assessed participant food security through questions adapted from the USDA food security survey module. Participant anxiety, depression, and stress scores were aggregated from questions adapted from the PHQ-4. A multiple logit regression model was utilized to estimate the risk associated with food security status and the surveyed variables. Anecdotal evidence was also collected to understand pandemic specific factors impacting participant food security. Results: Food insecurity was linked to significantly increased risk of anxiety, depression and stress. Those who identify to be food insecure have an 811 % increased risk of anxiety, 411% increased risk of depression, and 535% increased risk of stress compared to those who are food secure. In addition, a significant correlation exists between median household income and poor mental health. Anecdotal evidence identifies poor job security, food distributions, and support networks as exacerbating factors towards participant’s declining mental health. Conclusions: Our findings highlights the exacerbated impact the pandemic has had on the food security and mental health of vulnerable populations. In the light of these results and anecdotal feedback, public health measures must focus on getting increased funding towards local food banks to increase the frequency of mobile distribution markets coupled with direct subsidies to allow for food purchases, especially for those households with children. Given its impact on mental health, food insecurity status should regularly be screened by physicians access to the right resources must be provided for those screening as high risk.

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Why Are Hungry College Students Not Seeking Help? Predictors of and Barriers to Using an On-Campus Food Pantry

Nutrients ◽

10.3390/nu10091163 ◽

2018 ◽

Vol 10 (9) ◽

pp. 1163 ◽

Cited By ~ 28

Author(s):

Aseel El Zein ◽

Anne Mathews ◽

Lisa House ◽

Karla Shelnutt

Keyword(s):

Food Security ◽

Food Insecurity ◽

Social Stigma ◽

The United States ◽

Student Loan ◽

United States Department ◽

Limited Information ◽

Cross Sectional ◽

Food Pantry ◽

The Impact

Background: The number of food pantries on U.S. college campuses has increased in response to students’ food insecurity, but limited information is available to describe the impact of this resource. The objective of this cross-sectional investigation was to examine the relationship between food insecurity and food pantry awareness, use, and perceived barriers to use. Methods: Students attending the University of Florida in fall 2017 (n = 899) completed the United States Department of Agriculture (USDA) Adult Food Security Survey and responded to questions about food pantry awareness and use. Sociodemographic data were also collected and included in multivariate logistic regression models. Results: While most students (70%) were aware of the existing food pantry, nearly a third of respondents were classified as being food insecure. After adjusting for sociodemographic correlates, factors such as identifying as being food insecure, international status, and receiving a student loan or a need-based federal financial aid (Pell grant) increased the likelihood of utilizing the campus food pantry. Despite these predictors, only 38% of food insecure students reported food pantry use. Among students who provided qualitative insights, four main barriers to using the on-campus food pantry were identified: social stigma, insufficient information on pantry use policies, self-identity, and inconvenient hours. Conclusions: Food security interventions and administrative policy should consider a new model of the traditional campus food pantry that reduces concerns of social stigma and is supported by clear and ongoing communications of operational procedures tailored for the college student population.

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Does Urban Agriculture Improve Food Security? Examining the Nexus of Food Access and Distribution of Urban Produced Foods in the United States: A Systematic Review

Sustainability ◽

10.3390/su10092988 ◽

2018 ◽

Vol 10 (9) ◽

pp. 2988 ◽

Cited By ~ 26

Author(s):

Alana Siegner ◽

Jennifer Sowerwine ◽

Charisma Acey

Keyword(s):

United States ◽

Systematic Review ◽

Food Security ◽

Urban Agriculture ◽

Low Income ◽

City Planning ◽

The United States ◽

Food Justice ◽

Community Food Security ◽

The Impact

The aim of our review is to critically analyze the urban agriculture and urban food systems literature in order to understand the impact of urban-produced foods on community food security. We examine the role of city planning, food policy, and civic engagement in creating spaces for urban agriculture in cities across the United States, and whether (and how) these spaces promote food justice and food security. Bringing together multidisciplinary literature on access to urban agriculture and the distribution of urban-produced foods in a thematic, systematic review, we point out gaps in the academic research that would benefit from further study. The review integrates academic literature generated from Web of Science searches with gray literature identified through Google Alerts. We find that while there is a strong focus on elucidating the multiple benefits of urban agriculture, there are few studies that robustly measure the impact of urban farms on improving food security in low-income communities. Much of the literature is theoretical, focused on the production potential of urban agriculture, while more work is needed to understand and overcome barriers to access and distribution among communities in need. We conclude with a set of recommendations for researchers, practitioners, and policymakers who seek to create spaces in cities for food justice, equity, access, and sovereignty.

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Comparing Trends Between Food Insecurity and Cigarette Smoking Among Adults in the United States, 1998 to 2011

American Journal of Health Promotion ◽

10.1177/0890117116660773 ◽

2016 ◽

Vol 31 (5) ◽

pp. 413-416 ◽

Cited By ~ 10

Author(s):

Matthew C. Farrelly ◽

Paul R. Shafer

Keyword(s):

Food Security ◽

Cigarette Smoking ◽

Food Insecurity ◽

Low Income ◽

Economic Recession ◽

Population Level ◽

The United States ◽

Current Smoker ◽

Cross Sectional ◽

Current Smoking

Purpose: Previous studies have shown that cigarette smoking is associated with higher rates and severity of food insecurity but do not address how population-level smoking rates change in response to changes in food security. Design: Trend analysis of serial cross-sectional data. Setting: Data from a representative survey of US households. Participants: Adults within households participating in both the Food Security Supplement and Tobacco Use Supplement of the Current Population Survey during 5 overlapping administrations from 1998 to 2011. Measures: A “current smoker” is defined as someone who indicated that they currently smoke on “some days” or “every day.” A household’s food security is coded as “secure” or “insecure,” according to responses to a food security scale, interpreted using a US Department of Agriculture standard. Analysis: Descriptive comparison of the roughly triennial trends in the prevalence of food insecurity and current smoking from 1998 to 2011. Results: The prevalence of food insecurity increased by 30% among adults overall versus 54% among current smokers, with most of the changes occurring following the economic recession of 2008 and 2009. Over this same period, the prevalence of current smoking declined by 33% among food-secure adults and only 14% among food-insecure adults. Conclusion: Food insecurity increased more markedly among adult smokers than nonsmokers, and the prevalence of smoking declined more slowly in food-insecure households, indicating that more low-income smokers are facing hunger, which may at least partly be due to buying cigarettes.

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Food Insecurity and COVID-19: Disparities in Early Effects for US Adults

Nutrients ◽

10.3390/nu12061648 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1648 ◽

Cited By ~ 23

Author(s):

Julia A. Wolfson ◽

Cindy W. Leung

Keyword(s):

Food Security ◽

Food Insecurity ◽

Low Income ◽

Basic Needs ◽

Poverty Line ◽

The United States ◽

Household Food Security ◽

The Us ◽

Federal Poverty Line ◽

Early Effects

The COVID-19 pandemic has dramatically increased food insecurity in the United States (US). The objective of this study was to understand the early effects of the COVID-19 pandemic among low-income adults in the US as social distancing measures began to be implemented. On 19–24 March 2020 we fielded a national, web-based survey (53% response rate) among adults with <250% of the federal poverty line in the US (N = 1478). Measures included household food security status and COVID-19-related basic needs challenges. Overall, 36% of low-income adults in the US were food secure, 20% had marginal food security, and 44% were food insecure. Less than one in five (18.8%) of adults with very low food security reported being able to comply with public health recommendations to purchase two weeks of food at a time. For every basic needs challenge, food-insecure adults were significantly more likely to report facing that challenge, with a clear gradient effect based on severity of food security. The short-term effects of the COVID-19 pandemic are magnifying existing disparities and disproportionately affecting low-income, food-insecure households that already struggle to meet basic needs. A robust, comprehensive policy response is needed to mitigate food insecurity as the pandemic progresses.

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Food insecurity among households with children during the COVID-19 pandemic: results from a study among social media users across the United States

Nutrition Journal ◽

10.1186/s12937-021-00732-2 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Niyati Parekh ◽

Shahmir H. Ali ◽

Joyce O’Connor ◽

Yesim Tozan ◽

Abbey M. Jones ◽

...

Keyword(s):

United States ◽

Social Media ◽

Food Security ◽

Food Insecurity ◽

Low Income ◽

Online Survey ◽

The United States ◽

Household Food Security ◽

United States Department ◽

Households With Children

Abstract Background In the United States, approximately 11% of households were food insecure prior to the COVID-19 pandemic. The present study aims to describe the prevalence of food insecurity among adults and households with children living in the United States during the pandemic. Methods This study utilized social media as a recruitment platform to administer an original online survey on demographics and COVID-related food insecurity. The survey was disseminated through an advertisement campaign on Facebook and affiliated platforms. Food insecurity was assessed with a validated six-item United States Department of Agriculture (USDA) Household Food Security Survey Module, which was used to create a six-point numerical food security score, where a higher score indicates lower food security. Individual-level participant demographic information was also collected. Logistic regressions (low/very-low compared with high/marginal food security) were performed to generate adjusted odds ratios (AOR) and 95%CIs for food insecurity and select demographic characteristics. Results Advertisements reached 250,701 individuals and resulted in 5,606 complete surveys. Overall, 14.7% of participants self-identified as having low or very low food security in their households, with higher prevalence (17.5%) among households with children. Unemployment (AOR:1.76, 95%CI:1.09–2.80), high school or lower education (AOR:2.25, 95%CI:1.29–3.90), and low income (AOR[$30,000-$50,000]:5.87, 95%CI:3.35–10.37; AOR[< $30,000]:10.61, 95%CI:5.50–20.80) were associated with higher odds of food insecurity in multivariable models among households with children (and the whole sample). Conclusions These data indicate exacerbation of food insecurity during the pandemic. The study will be instrumental in guiding additional research and time-sensitive interventions targeted towards vulnerable food insecure subgroups.

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