Midlife vulnerability and food insecurity: Findings from low-income adults in the US National Health Interview Survey.

BACKGROUND: Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging. METHODS: Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance. RESULTS: Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry. CONCLUSIONS: Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.

Purchases Made with a Fruit and Vegetable Voucher in a Rural Mexican-Heritage Community.

Recent recommendations for US food assistance programs are intended to ensure foods provided through these programs help households consume a varied, healthful diet. From a policy viewpoint, it is important to examine the impact of economic incentives to purchase healthy foods across subpopulations, particularly low-income Latinos, who comprise 40% of the WIC program nationwide. Our aim was to determine how rural, Mexican-heritage households (N = 227) residing in California's Central Valley distributed fruit and vegetable (F/V) voucher spending among F/V subgroups and specific items over a 1-year period. Households contained at least one child who was between 3 and 8 years old at baseline and had a parent of Mexican-heritage. F/V voucher purchase data were collected via grocery store scanners. Expenditure and frequency shares of subgroups and individual items were analyzed to determine purchasing habits. Fruits were the most commonly purchased subgroup, representing 55% of spending and 45% of frequency. Households allocated low percentages of their voucher to dark green and red/orange vegetables-7 and 9% respectively. Approximately 20% of purchases were good potassium sources and 30% of purchases were good fiber sources. Many of the most frequently purchased items were of cultural significance (tomatillo, chayote, chili/jalapeño pepper, and Mexican squash). This study suggests that economic incentives can contribute important nutrients to participants' diets and targeted vouchers provided by food assistance programs should continue to include culturally important foods and be aware of the cultural values of their participants.

Assessing Child Obesity and Physical Activity in a Hard-to-Reach Population in California's Central Valley, 2012-2013.

INTRODUCTION: In California's agricultural Central Valley, the rate of childhood obesity is higher than the national average. Adequate physical activity contributes to obesity prevention and its assessment is useful to evaluate the impact of interventions. METHODS: Niños Sanos, Familia Sana (Healthy Children, Healthy Family [NSFS]) uses community-based participatory research to implement an intervention program to reduce childhood obesity among people of Mexican origin in the Central Valley. Anthropometric measurements were conducted on more than 650 children enrolled in NSFS. Physical activity data from a subgroup of children aged 4 to 7 years (n = 134) were collected via a wearable accelerometer. RESULTS: Children were classified on the basis of age and sex-adjusted body mass index as healthy weight (57.7%); overweight (19.3%), or obese (23%). Logistic regression showed that moderate to vigorous physical activity (MVPA) was associated with a child's likelihood of having a healthy BMI (odds ratio: 1.03; 95% CI, 1.01-1.05; P = .017). CONCLUSION: NSFS's community-based participatory approach resulted in successful use of a commercial electronic device to measure physical activity quantity and quality in this hard-to-reach population. Promotion of adequate daily MVPA is an appropriate and necessary component of NSFS's childhood obesity prevention strategy.

Food Resource Management Education With SNAP Participation Improves Food Security.

OBJECTIVE: To determine the influence of Supplemental Nutrition Assistance Program (SNAP) and participant demographics on nutrition education outcomes. METHODS: At program enrollment (pre) and 1 month later (post), a statewide convenience sample of adults, who participated in the Plan, Shop, Save, and Cook program, completed a 7-item questionnaire to evaluate change in resource management skills (RMS) and running out of food before the end of the month. RESULTS: Percent of participants (n = 3,744) who reported behavioral improvements in RMS ranged from 38.8% in comparing prices to 54% in reading labels. Female gender and Hispanic ethnicity were positively related to pre-post RMS change (P = .001). Participants who received SNAP food assistance and made greater pre-post improvement in RMS reported the greatest decrease in running out of food (P = .001). CONCLUSIONS AND IMPLICATIONS: Both food assistance and education on nutrition and resource management are needed to reduce food insecurity in SNAP-eligible audiences.

Child feeding practices and overweight status among Mexican immigrant families.

The purpose was to compare maternal perceptions, feeding practices, and overweight status of children in immigrant households in California (US) with a cohort in Guanajuato, Mexico (MX). In 2006, staff interviewed mothers and weighed and measured their children, 1-6 years (US: n = 95 and MX: n = 200). Prevalence of overweight [body mass index z-score (BMIZ) >1.0 and <1.65] and obesity (BMIZ > 1.65) was 21.1 and 28.4% in the US respectively, compared to 11.5 and 12.9% in MX (p < 0.001). No differences were observed in maternal ability to identify correctly the child's weight status or ever being told the child was overweight. US children ate away from home more often (p < 0.0001), had fewer family meals (p < 0.0001), and played outdoors less often than MX children (p < 0.0002). Further analyses should examine how differences in eating and activity patterns explain the disparity in childhood obesity across the countries.

Acculturation, physical activity and television viewing in Hispanic women: findings from the 2005 California Women's Health Survey.

OBJECTIVE: To assess the relationship of acculturation with physical activity and sedentary behaviours among Hispanic women in California. DESIGN: Data from the 2005 California Women's Health Survey (CWHS) - a cross-sectional telephonic survey of health indicators and health-related behaviours and attitudes - were used. SETTING: Using a random-digit dialling process, data were collected monthly from January to December 2005. SUBJECTS: A total of 1298 women aged ≥18 years in California who self-identified as Hispanic. RESULTS: Of the participants included in the analysis, 49 % were adherent to physical activity recommendations (with 150 min of weekly activity signifying adherence). There was no significant association between language acculturation and moderate or vigorous physical activity after controlling for potential confounders such as smoking, age and employment status. There was also no association between duration of residence in the USA and moderate or vigorous physical activity. Language acculturation was positively associated with television (TV) viewing, with highly acculturated women reporting more hours of TV viewing compared with women with an intermediate acculturation score (P = 0·0001), and those with an intermediate score reporting more hours of TV viewing compared with those with a low score (P = 0·003). This relationship persisted after inclusion of smoking, employment status, age and education in the model. CONCLUSIONS: Higher levels of language acculturation may be associated with increased sedentary behaviours because of the influence of US culture on those women who have assimilated to the culture. Acculturation is an important factor to be taken into account when designing health education interventions for the Hispanic female population.

Impact of vaccination against chicken Newcastle disease on food intake and food security in rural households in Tanzania.

BACKGROUND: Small-scale poultry production has the potential to increase animal-source food consumption, improve household income, and reduce food insecurity. OBJECTIVE: To assess the impact of a chicken Newcastle disease vaccination program on consumption of chicken and eggs among women and children, income, and food insecurity in rural Tanzanian households. METHODS: Comparisons were made between households from three project villages, which participated in a Newcastle disease vaccination program for chickens, and three control villages, which did not participate. Household interviews were done with mothers from a random sample in March 2008 (237 households) and March 2009 (261 households). RESULTS: After the first year of vaccinations (three rounds), project households kept significantly more chickens and tended to be more food secure than control households. Mothers from project households ate significantly more eggs than their counterparts in control households. A similar trend was observed among children. In 2009, fewer chickens were vaccinated in the project villages than in 2008, and more chickens were independently vaccinated in the control villages. This corresponded with an increase in ownership of chickens, a reduction in food insecurity, and improved consumption of eggs in control villages, whereas chicken ownership and egg consumption decreased and food insecurity remained relatively stable in project villages. We saw no differences between project and control villages in income earned from chicken and egg sales. CONCLUSIONS: Our findings suggest that an increase in chicken Newcastle disease vaccination can lead to an increase in ownership of chickens and egg consumption and may also have an effect on reducing household food insecurity.

Using qualitative methods to improve questionnaires for Spanish speakers: assessing face validity of a food behavior checklist.

Development of outcome measures relevant to health nutrition behaviors requires a rigorous process of testing and revision. Whereas researchers often report performance of quantitative data collection to assess questionnaire validity and reliability, qualitative testing procedures are often overlooked. This report outlines a procedure for assessing face validity of a Spanish-language dietary assessment tool. Reviewing the literature produced no rigorously validated Spanish-language food behavior assessment tools for the US Department of Agriculture's food assistance and education programs. In response to this need, this study evaluated the face validity of a Spanish-language food behavior checklist adapted from a 16-item English version of a food behavior checklist shown to be valid and reliable for limited-resource English speakers. The English version was translated using rigorous methods involving initial translation by one party and creation of five possible versions. Photos were modified based on client input and new photos were taken as necessary. A sample of low-income, Spanish-speaking women completed cognitive interviews (n=20). Spanish translation experts (n=7) fluent in both languages and familiar with both cultures made minor modifications but essentially approved client preferences. The resulting checklist generated a readability score of 93, indicating low reading difficulty. The Spanish-language checklist has adequate face validity in the target population and is ready for further validation using convergent measures. At the conclusion of testing, this instrument may be used to evaluate nutrition education interventions in California. These qualitative procedures provide a framework for designing evaluation tools for low-literate audiences participating in the US Department of Agriculture food assistance and education programs.

Why do low-income women not use food stamps? Findings from the California Women's Health Survey.

OBJECTIVE: To determine factors associated with Food Stamp Program (FSP) participation in a potentially eligible California population. DESIGN: The California Women's Health Survey is an on-going annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Statistical procedures included chi2 and logistic regression. SETTING: California, USA, from 2002 to 2004. SUBJECTS: A total of 527 FSP female participants and 1405 potentially eligible non-participant females, aged 18 years and older. RESULTS: The following characteristics remained independently and positively related to FSP participation: single mother with children; unemployed; on welfare; on WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children); and US-born. Women under 25 years and those over 54 years were less likely to participate than women aged 25-54 years. Hispanic/Latino ethnicity was also negatively related to participation. Over 42 % of potentially eligible non-participants cited 'don't need them' as the reason for not applying for FSP, but 34.9 % either do not think they are eligible or do not know how to apply. Potentially eligible non-participants who cite 'don't need them' as a reason for not applying are less likely to be food insecure, to have inadequate income and to use alternative emergency aid, compared to women citing all other reasons. The highest level of need is among those who cite worry about citizenship or stigma as reasons for not applying. CONCLUSION: Strategies to increase participation in FSP should incorporate messages that change the public's perception of the programme, in addition to simplifying the application process, raising awareness of eligibility criteria and improving customer service.

Who is food-insecure in California? Findings from the California Women's Health Survey, 2004.

OBJECTIVE: To identify factors associated with food insecurity in California women. DESIGN: The California Women's Health Survey is an ongoing annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Food insecurity of the women was measured by a 6-item subset of the Food Security Module. Statistical procedures included chi-square tests, t-tests, logistic regression analysis and analysis of covariance. SETTING: California, USA. SUBJECTS: Four thousand and thirty-seven women (18 years or older). RESULTS: Prevalence of food insecurity was 25.7%. After controlling for income, factors associated with greater food insecurity were Hispanic or Black race/ethnicity; less than a 12th grade education; being unmarried; less than 55 years old; being Spanish-speaking; having spent less than half of one's life in the USA; sadness/depression; feeling overwhelmed; poor physical/mental health interfering with activities; and fair to poor general health. Among Food Stamp Program (FSP) participants, 71% were food-insecure. Among FSP-eligible women who had not applied for the programme, the prevalence of food insecurity was lower among women responding that they did not need food stamps than in women giving other reasons for not applying (23.9% vs. 66.9%, P < 0.001). Factors associated with food insecurity in FSP recipients included being unable to make food stamps last for 30 days, feeling overwhelmed, and having a birthplace in Mexico or Central America. CONCLUSIONS: Along with several socio-economic variables, poor physical and mental health is associated with food insecurity. Whether food insecurity is a cause or effect of poor health remains in question.

Development of a tool to assess psychosocial indicators of fruit and vegetable intake for 2 federal programs.

OBJECTIVE: Development of an evaluation tool of psychosocial constructs for use by participants in 2 federal programs, Food Stamp Nutrition Education and the Expanded Food and Nutrition Education Program. DESIGN: Cross-sectional data from a longitudinal study. PARTICIPANTS: Limited-resource women (n = 111) living in low-income communities. MEASURES: Test-retest reliability, internal consistency, ethnic differences, convergent validity. ANALYSIS: Spearman rank order correlation, analysis of variance, principal components analysis. RESULTS: Reliability coefficients ranged from a low of r = .18 (not significant) to r = .74 (P < .0001). Two items were deleted for not meeting criteria for reliability and 2 for redundancy. Ethnic differences at baseline were significant for 1 item. Domain constructs loaded on 4 to 5 factors for the biopsychosocial framework. Estimates of convergent validity of 9 constructs led to the deletion of 3 (ie, perceived barriers, social support, and perceived norms), with retention of perceived benefits, perceived control, self-efficacy, readiness to eat more fruit, readiness to eat more vegetables, and perceived diet quality. As an estimate of convergent validity, the final version of the tool with 6 constructs remaining showed significant correlations with indicators of diet quality: serum carotenoid values (r = .38, P < .001); hypothesized nutrients calculated from the mean of 3 24-hour dietary recalls (vitamin C, r = .47, P < .0001; vitamin A, r = .39, P < .0001; folate, r = .37, P < .0001; beta-carotene, r =.31, P < .001; and fiber, r = .46, P < .0001); fruit and vegetable servings (r = 0.55, P < .0001); Healthy Eating Index (r = .27, P < .05); and a fruit and vegetable behavioral scale (r = .60, P < .0001). CONCLUSION AND IMPLICATIONS: This systematic process yielded a fruit and vegetable evaluation tool useful for practitioners and researchers. This is the first validation study of this type to estimate convergent validity with 5 indicators of diet quality, including a biomarker.

[Food insecurity among Californian Latinos: focus-group observations]. / Inseguridad alimentaria en latinos de California: observaciones de grupos focales.

OBJECTIVE: To assess the perception and experience with food insecurity among Latinos living in California, as well as their interpretation of the items included in the Food Security Scale. MATERIAL AND METHODS: A series of four focus groups were carried out among 30 adults of Latin-American descent living in California. The participant's responses were coded by two researchers to identify the main issues, and to compare them for assessing their convergence. RESULTS: The items were well understood and were not perceived as offensive. The conceptual framework was confirmed as a "managed process" with different severity levels. The causes of food insecurity were: unemployment, high cost of some food items, and lack of nutritional information. The demand for nutritional education was constant. CONCLUSION: Interpreting data on food insecurity in Latinos requires proper consideration of their particular perceptions.

Inseguridad alimentaria en latinos de California: observaciones de grupos focales / Food insecurity among Latinos in California: A focal groups study

OBJETIVO: Estudiar la percepción y la experiencia sobre inseguridad alimentaria entre latinoamericanos de California, así como su interpretación de los insumos incluidos en la Escala de Seguridad Alimentaria. MATERIAL Y MÉTODOS: Entre noviembre y diciembre de 2000, en los condados californianos de Solano y San Joaquín, se efectuaron cuatro grupos focales, con 30 adultos de origen latinoamericano residentes allí. Los comentarios de los participantes fueron codificados por dos investigadores para determinar los temas principales, y fueron confrontados para verificar su convergencia. RESULTADOS: Las preguntas fueron bien comprendidas, no percibiéndose como ofensivas. El marco conceptual se confirmó como "proceso manejado" con diferentes niveles de severidad. Las causas de inseguridad alimentaria identificadas fueron: desempleo, alto costo de algunos alimentos y falta de información nutricional. La necesidad de educación nutricional fue una constante. CONCLUSIONES: Para interpretar datos nacionales de inseguridad alimentaria en latinoamericanos es esencial considerar su percepción particular de ese fenómeno

Selecting items for a food behavior checklist for a limited-resource audience.

OBJECTIVE: To report 6 psychometric properties of food behavior checklist (FBC) items and then to use these properties to systematically reduce the number of items on this evaluation tool. DESIGN: Random assignment to the intervention and control groups. SETTING: Low-income communities. PARTICIPANTS: Women (N = 132) from limited-resource families. MAIN OUTCOME MEASURES: Reliability, internal consistency, baseline differences by ethnicity, sensitivity to change, and criterion and convergent validity of subscales. RESULTS: The fruit and vegetable subscale showed a significant correlation with serum carotenoid values (r =.44, P <.001), indicating acceptable criterion validity. Milk, fat/cholesterol, diet quality, food security, and fruit/vegetable subscales showed significant correlations with dietary variables. Nineteen items have acceptable reliability. Twenty items showed no baseline differences by ethnic group. Eleven of the 15 items expected to show change following the intervention demonstrated sensitivity to change. CONCLUSIONS AND IMPLICATIONS: This brief food behavior checklist (16 items) is easy to administer to a client group, has an elementary reading level (fourth grade), and has a low respondent burden in addition to meeting requirements for validity, reliability, and sensitivity to change. This study establishes a process that can be used by other researchers to develop and further refine instruments for use in community health promotion interventions.

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.