Relative food insecurity, mental health and wellbeing in 160 countries.

Food insecurity contributes to various stress-related health problems and previous research found that its association with mental illness is stronger in more affluent countries. We hypothesised that this pattern is a function of relative deprivation whereby the severity of individual food insecurity relative to others in a reference group determines its associations with mental health and wellbeing after differences in absolute food insecurity are controlled for. Using survey data from the Gallup World Poll collected in 160 countries and a measure of relative deprivation (Yitzhaki index), we found that relative food insecurity-based on national or regional reference groups-related to more mental health symptoms, lower positive wellbeing and lower life satisfaction after controlling for absolute food insecurity, household income, and country differences. Our analysis also found that relative food insecurity was more strongly related to mental health and wellbeing where the prevalence of food insecurity was lower. The findings underscore the negative health consequences of material deprivation and unfavourable social comparisons. Consistent with relative deprivation theory, individuals who live with constant worries about not getting enough food, have to skip meals, or face chronic hunger are deprived of material and social resources that support mental health and wellbeing, especially in settings where food insecurity is less common and potentially more stigmatised. The implications of these findings for global food policy and surveillance efforts are discussed.

Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer.

Scale development and validation are critical to much of the work in the health, social, and behavioral sciences. However, the constellation of techniques required for scale development and evaluation can be onerous, jargon-filled, unfamiliar, and resource-intensive. Further, it is often not a part of graduate training. Therefore, our goal was to concisely review the process of scale development in as straightforward a manner as possible, both to facilitate the development of new, valid, and reliable scales, and to help improve existing ones. To do this, we have created a primer for best practices for scale development in measuring complex phenomena. This is not a systematic review, but rather the amalgamation of technical literature and lessons learned from our experiences spent creating or adapting a number of scales over the past several decades. We identified three phases that span nine steps. In the first phase, items are generated and the validity of their content is assessed. In the second phase, the scale is constructed. Steps in scale construction include pre-testing the questions, administering the survey, reducing the number of items, and understanding how many factors the scale captures. In the third phase, scale evaluation, the number of dimensions is tested, reliability is tested, and validity is assessed. We have also added examples of best practices to each step. In sum, this primer will equip both scientists and practitioners to understand the ontology and methodology of scale development and validation, thereby facilitating the advancement of our understanding of a range of health, social, and behavioral outcomes.

Validity and reliability of food security measures.

This paper reviews some of the existing food security indicators, discussing the validity of the underlying concept and the expected reliability of measures under reasonably feasible conditions. The main objective of the paper is to raise awareness on existing trade-offs between different qualities of possible food security measurement tools that must be taken into account when such tools are proposed for practical application, especially for use within an international monitoring framework. The hope is to provide a timely, useful contribution to the process leading to the definition of a food security goal and the associated monitoring framework within the post-2015 Development Agenda.

Correlates of fruit and vegetable intakes in US children.

The objective of this study was to assess the quality of the current intakes of fruits and vegetables compared to the Dietary Guidelines for Americans in US children and adolescents and identify factors related to low fruit and vegetable intake. This descriptive study examined differences in fruit and vegetable intakes by age, sex, ethnicity, poverty level, body mass index, and food security status utilizing data from the 1999-2002 National Health and Nutrition Examination Survey. Six thousand five hundred thirteen children and adolescents ages 2 to 18 years, who were respondents to the 1999-2002 National Health and Nutrition Examination Survey. Mean fruit and vegetable intakes were computed using 24-hour recalls for individuals and compared using analysis of variance. Leading contributors to fruit and vegetable intake were identified using frequency analysis. Children aged 2 to 5 years had significantly higher total fruit and juice intakes than 6- to 11- and 12- to 18-year-olds. Total vegetable and french fry intake was significantly higher among 12- to 18-year-old adolescents. Regarding sex differences, boys consumed significantly more fruit juice and french fries than girls. In addition, non-Hispanic African-American children and adolescents consumed significantly more dark-green vegetables and fewer mean deep-yellow vegetables than Mexican-American and non-Hispanic white children and adolescents. Total fruit consumption also differed significantly among race/ethnicities and household income. Children and adolescents most at risk for higher intakes of energy-dense fruits and vegetables (fruit juice and french fries) were generally boys, and adolescents, at risk for overweight or overweight and living in households below 350% of the poverty level.

Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines.

This study examined the association between food insecurity, determined by a modified version of the U.S. Household Food Security Survey Module (US HFSSM), and total daily per capita (DPC) consumption (measured as household expenditures) in Bolivia, Burkina Faso, and the Philippines. Household food insecurity was determined by an adapted 9-item US HFSSM version. A short version of the World Bank's Living Standards Measurement Study (LSMS) consumption module measured household expenditures. Focus groups were used to adapt the survey instrument to each local context. The sample (n approximately 330 per country) includes residents of urban and rural areas. A 12-month food expenditure aggregate was generated as part of the total household expenditures calculation. DPC food expenditure, which represented over 60% of the total household consumption, as well as expenditures on specific food groups correlated with food insecurity both as a continuous Food Insecurity Score (FinSS) and a tricategorical food insecurity status variable. ANOVA and regression analysis were executed adjusting for social and demographic covariates. Food-secure households have significantly higher (P < 0.05) total DPC food expenditures as well as expenditures on animal source foods, vegetables, and fats and oils than moderately and severely food-insecure households. The results offer evidence that the US HFSSM is able to discriminate between households at different levels of food insecurity status in diverse developing world settings.

Choice of instrument influences relations between food insecurity and obesity in Latino women.

BACKGROUND: The results of studies examining food insecurity and obesity in adults are conflicting. Discrepancies could be due to the use of different instruments or to cultural factors that influence response patterns. OBJECTIVE: The goal was to examine the relation of food insecurity to weight status in low-income Latino women. DESIGN: A cross-sectional survey was conducted among 559 low-income Latino women selected by convenience sampling. The survey included the 18-item US Household Food Security Scale, 2 items related to current and past food insufficiency, demographic information, and measured heights and weights. Data were collected between February and May 2001 in 6 California counties. The main outcomes were frequency of overweight and obesity, defined by a body mass index (in kg/m(2)) of 25-29.9 (overweight) and >30 (obese). Data analysis included analysis of variance, Mantel-Haenszel chi-square test, and logistic regression. RESULTS: The prevalence of food insecurity was 50-60%, and that of obesity was 37.4%. Controlling for years spent in the United States, per capita income, and parity, food insecurity with hunger, measured by the 10-item adult scale of the Food Security Scale, was significantly related to obesity (OR: 1.98; 95% CI: 1.14, 3.53). No interaction between years spent in the United States and current food insecurity was observed. Current food insufficiency, as measured by a single item, was not related to obesity. However, severe past food insufficiency was related to obesity in the US-born population only. CONCLUSION: Food insecurity appears to be related to obesity in Latino women, but choice of instruments might influence the results.

Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children.

OBJECTIVE: The purpose of this research was to examine the relationship of child-feeding practices and other factors to overweight in low-income Mexican-American preschool-aged children. DESIGN: Cross-sectional survey with anthropometric measurements of mothers and target children. Trained bilingual staff interviewed the parents to collect data on child-feeding strategies, food patterns, child's health history, parental acculturation level, food insecurity, and other household characteristics. Subjects and setting Complete data were available from 204 low-income Mexican-American parents residing in California with at least one child aged 3 to 5 years. Outcomes measured Risk of overweight was defined as body mass index (BMI) (measured as weight [in kilograms]/height [in meters](2)) >/=85th percentile and overweight was defined as BMI >/=95th percentile. The Student t test, chi(2) test, and logistic regression were used. RESULTS: Three variables were positively related to risk of overweight: birth weight (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.11 to 4.82), mother's BMI >/=30 (OR, 2.05; 95% CI, 1.11 to 3.79), and juice intake (OR, 2.33; 95% CI, 1.09 to 4.98). Being enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children was negatively related to risk of overweight (OR, 0.40; 95% CI, 0.21 to 0.75). Additional variables related to overweight were monthly income >$1,500 (OR, 2.33; 95% CI, 1.00 to 5.42) and child takes food from the refrigerator between meals (OR, 0.32; 95% CI, 0.13 to 0.76). CONCLUSIONS: The results of this study suggest that biological and socioeconomic factors are more associated with overweight in Mexican-American preschool-aged children than most of the self-reported child-feeding strategies.

Food security and nutritional outcomes of preschool-age Mexican-American children.

OBJECTIVE: To examine the relationship of food insecurity to nutrition of Mexican-American preschoolers. DESIGN: Cross-sectional survey of low-income Mexican-American families with children of preschool age (3 to 6 years). Data included food security using the Radimer/ Cornell scale; acculturation; parental education; monthly income; past experience of food insecurity; and child weight, height, and frequency of consuming 57 foods. Weight-for-height z scores (WHZ), height- for-age z (HAZ) scores, and the percentage of overweight (> or = 85th percentile WHZ) were calculated. SUBJECTS/SETTING: A convenience sample of Mexican-American families (n=211) was recruited through Head Start, Healthy Start, Migrant Education, and the Special Supplemental Nutrition Program for Women, Infants, and Children in Tulare, Fresno, Monterey, and Kern counties in California. Statistical analyses Analysis of variance, t tests, Spearman's correlations, and Mantel Haenszel chi2. RESULTS: Limited education, lack of English proficiency, and low income were negatively correlated with food security (r = -0.31 to -0.44, P<.0001). After controlling for acculturation, children in severely food-insecure households were less likely to meet Food Guide Pyramid guidelines than other children (median number of food groups > or = recommended levels [interquartile range]: 2.0 (2.0) vs 3.0 (2.0), P<.006). Although WHZ (mean +/- SD = 1.28 +/- 1.80) and percent overweight (48%, N=19) tended to peak among children from household level food insecure families, no significant differences were found in weight or height status of children by level of food insecurity. APPLICATIONS/CONCLUSIONS: Dietetics professionals working with low-income Hispanic-American families should screen for different levels of food insecurity to determine needs for nutrition education and other services.