Household Flood Severity and Migration Extent in Central Java: Analysis of the Indonesian Family Life Survey.

Central Java, Indonesia, is prone to river and coastal flooding due to climate changes and geological factors. Migration is one possible adaptation to flooding, but research is limited due to lack of longitudinal spatially granular datasets on migration and metrics to identify flood-affected households. The available literature indicates social and economic barriers may limit mobility from flood prone areas. The Indonesian Family Life Survey (IFLS) provides self-reported data on household experiences with natural disasters among 1501 Central Java households followed over two waves (2007 and 2014). We examined how the severity of flooding, defined by household-level impacts captured by the IFLS (death, injury, financial loss, or relocation of a household member), influenced the extent of household movement in Central Java using a generalized ordered logit/partial proportional odds model. Households severely impacted by floods had 75% lower odds of moving farther away compared to those that did not experience floods. The most severely impacted households may be staying within flood-affected areas in Central Java. Public health, nutrition, and economic surveys should include modules focused on household experiences, impacts, and adaptations to facilitate the study of how climate changes are impacting these outcomes.

Fish-To Eat or Not to Eat? A Mixed-Methods Investigation of the Conundrum of Fish Consumption in the Context of Marine Pollution in Indonesia.

Background: The Indonesian government faces a dilemma of promoting fish consumption for its health benefits and to ease food insecurity, while at the same time seeking effective approaches to reduce the high levels of marine pollution. However, the factors associated with fish consumption in the face of persistent high levels of marine pollution are not well elucidated in the literature. Objectives: This was an explorative study to investigate the sociodemographic factors related to fish consumption and to understand the perspectives of expert informants on marine pollution and its impact on fish quality and availability in Indonesia. Methods: We characterized fish consumption among respondents aged 15 years and older in the fifth wave of the Indonesian Family Life Survey (n = 31,032), based on their sociodemographic profiles, and developed multinomial regression models to assess the relationship between respondents' sociodemographic profiles and quintiles of fish consumption. We also conducted in-depth interviews on fish consumption and marine pollution with key informants from Indonesia (n = 27). We then used a convergent mixed-methods design to synthesize the results of both datasets. Results: Fish was the most frequently consumed animal-source food reported by survey respondents: 2.8 (±2.6) days/week. More younger respondents (15-19 years) reported relatively lower consumption of fish (9.3% in Q1 versus 5.9% in Q5) compared to respondents 50 years and older (37% in Q1 versus 39.9% in Q5; p < 0.01). When classified by region, more respondents from the Java region reported lower consumption of fish (86.5% in Q1 versus 53% in Q5; p < 0.01). Key-informants' perspectives corroborated the survey results by indicating that the younger generation tends not to want to consume fish; informants expanded the survey results by suggesting that fish is scarce in the Java region due to high levels of marine pollution. Informants further implied that there is low awareness about the impact of marine pollution on fish quality among most of the Indonesian population. Conclusion: Evidence from both data sources converge on differential preference for fish consumption by age group. Informants' perspectives also link marine pollution to fish scarcity, which poses a threat to food security among low-income Indonesians and to human health globally. More studies are needed to corroborate our findings and inform policy guidelines to reduce marine pollution while promoting fish consumption in Indonesia.

The Effects of the COVID-19 Pandemic on Nutrition, Health and Environment in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Experts.

OBJECTIVES: The COVID-19 pandemic impacted food systems, health systems and the environment globally, with potentially greater negative effects in many lower-middle income countries (LMICs) including Indonesia. The purpose of this qualitative study was to investigate the potential impacts of the COVID-19 pandemic on diets, health and the marine environment in Indonesia, based on the perspectives of a multidisciplinary group of informants. METHODS: We conducted remote in-depth interviews with 27 key informants from many regions of Indonesia, who are either healthcare providers, nutrition researchers or environmental researchers. Interview question guides were developed based on a socio-ecological framework. We analyzed the data using a qualitative content analysis approach. RESULTS: Informants suggested that while the COVID-19 brought increased awareness about and adherence to good nutrition and health behaviors, the impact was transitory. Informants indicated that healthy food options became less affordable, due to job losses and reduced income, suggesting a likely increase in food insecurity and obesity. Environmental researchers described higher levels of marine pollution from increase in hygienic wastes as well as from plastic packaging from food orders. CONCLUSIONS: Our findings reveal perceptions by informants that the increased awareness and adherence to health behaviors observed during the pandemic was not sustained. Our results also suggest that the pandemic may have exacerbated the double-burden paradox and marine pollution in Indonesia. This study offers information for generating hypotheses for quantitative studies to corroborate our findings and inform policies and programs to mitigate the long-term impacts of the COVID-19 on diets, health, and the marine environment in Indonesia.

A Cross-Sectional Assessment of Dietary Patterns and Their Relationship to Hypertension and Obesity in Indonesia.

Background: There is a marked increase in the intake of foods associated with higher risks for hypertension and obesity in Indonesia. However, studies assessing the relationship between dietary patterns and health outcomes are few. Objective: The purpose of this study was to characterize dietary patterns and investigate their relationship with hypertension and obesity in Indonesia. Methods: Exploratory factor analysis was used to derive dietary patterns from a brief food scanner filled by 31,160 respondents aged 15 y and older in the Indonesian Family Life Survey wave 5 (IFLS 5). Age- and gender-specific quintiles of consumption were created for each pattern and the association between quintiles of each dietary pattern and the odds for hypertension and obesity were assessed using multivariate logistic regression analyses. Results: Two dietary patterns were identified: a modern dietary pattern characterized by fast foods, soft drinks, sweet snacks, and salty snacks and a traditional pattern characterized by fish, vegetables, and fruits. Younger age and being male were significantly correlated with higher consumption of the modern pattern (P < 0.0001 and P = 0.03, respectively). Analyses showed no association between hypertension and the modern pattern. However, the traditional pattern revealed lower odds for hypertension among those in the highest quintile compared with the lowest quintile (OR: 0.84; 95% CI: 0.74, 0.95; P-trend < 0.05). Individuals in the highest quintile of each dietary pattern had higher odds of obesity compared with those in the lowest quintile (modern pattern-OR: 1.31; 95% CI: 1.15, 1.49; P-trend < 0.00; traditional pattern-OR: 1.25; 95% CI: 1.10, 1.42; P-trend < 0.01). Conclusions: More studies using gold-standard measures of dietary intake are needed to better understand the relationship between the modern dietary pattern and hypertension in Indonesia. Also, both modern and traditional dietary patterns in Indonesia may be energy dense, leading to higher risk for obesity.

The Role of Household Assets in Improving Women's Dietary Diversity in Ethiopia.

Background: ENGINE (Empowering New Generations for Improved Nutrition and Economic Opportunities) was a US Agency for International Development (USAID)-funded project implemented in Ethiopia from 2011 to 2016. ENGINE used a multisectoral approach to achieve the goals articulated in the Government of Ethiopia's National Nutrition Plan, among which is improvement in the dietary intakes of women and preschool-aged children. Objectives: The objectives of the present research are 2-fold: 1) to document trends in women's dietary diversity (WDD) and 2) to identify factors associated with dietary diversity for women. Methods: Descriptive statistics and multivariate, pooled analyses were calculated. Results: Results indicate that WDD was low, ranging, on average, from 3.0 to 4.0 (out of a possible 10). Across the time points covered reflecting pregnancy and 1-y postpartum, only ∼13% to 17% of women met the Minimum Dietary Diversity Score for Women (MDD-W). Conclusions: The production of both food and cash crops and the rearing of livestock were significant predictors of improved dietary diversity in women. The focus of ENGINE on a diverse set of agricultural activities improved WDD and MDD-W in a population of women where dietary diversity is poor.

Dietary Outcomes, Nutritional Status, and Household Water, Sanitation, and Hygiene (WASH) Practices.

Background: The Government of Ethiopia has made a major commitment toward improving food security, diet, nutrition, and health through a series of national nutrition plans. The focus of these plans is on providing both nutrition-specific as well as nutrition-sensitive approaches for achieving national priorities for health and nutrition. The present study conducted a secondary analysis of data provided through a larger birth cohort study conducted in Ethiopia between 2014 and 2016. Objectives: The overall objectives of this research were to assess the relation between minimum dietary diversity in women and water, sanitation, and hygiene (WASH), and evaluate the association between midupper arm circumference (MUAC) in women and WASH. Methods: In addition to descriptive statistics, the study used mixed effects logistic regression analyses to investigate the relation between dietary diversity, MUAC, and household WASH practices. Results: Improved WASH practices were associated with an increased probability (p = 0.04) that a woman would consume a diet with foods from 5 or more food groups. A beneficial effect was observed for improved WASH practices and a decrease in low MUAC. Improved household WASH practices were successful in contributing to improved dietary diversity in women as well as an improved MUAC. Conclusions: Interventions aimed at improving the diet and nutritional status of women during and after pregnancy should include relevant WASH components as essential elements in multisector nutrition programming.

Food Choice With Economic Scarcity and Time Abundance: A Qualitative Study.

Consumers with low income in the United States have higher vulnerability to unhealthy diets compared with the general population. Although some literature speculates that scarcity is an explanation for this disparity, empirical evidence is lacking. We conducted a qualitative study of food choice to explore whether scarcity-related phenomena, such as tunneling and bandwidth tax, may contribute to unhealthy dietary choices. We used participant-driven photo elicitation (n = 18) to investigate the food choice behaviors of individuals living in the greater Boston area who met the federal guidelines for poverty. Participants took photos at the point of food acquisition for 1 month, after which we interviewed them using a semistructured interview guide with the photos as prompts. Thematic coding was used for analysis. Respondents had relative time abundance. Two major themes emerged: participants used a set of strategies to stretch their budgets, and they highly prioritized cost and preference when making food choices. The extreme focus on obtaining food at low cost, which required time and effort, was suggestive of tunneling. We found no evidence of the bandwidth tax. Our findings raise the hypothesis of scarcity as a continuum: when individuals experience multiple resource constraints, they experience scarcity; whereas people with very limited finances and relative time abundance may instead be in a prescarcity condition, with a hyperfocus on a scarce resource that could lead to tunneling as constraints increase. Additional studies are needed to understand whether and how tunneling and bandwidth tax emerge, independently or together, as people face different levels and types of scarcity.

The Socio-Ecological Context of the Nutrition Transition in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Stakeholders.

Background: Indonesia is undergoing a rapid nutrition transition­a shift in food consumption related to globalization, modernization, urbanization, and economic development­with potentially adverse impacts on diets, health, and the environment. This study sought to understand the perspectives of a multi-disciplinary group of experts on the effects of the nutrition transition on dietary behaviors, cardiovascular disease (CVD) risk factors, and the food environment in Indonesia. Methods: In-depth interviews were conducted online with 27 Indonesian experts, who are either healthcare providers, nutrition researchers, or environmental researchers. Interview question guides were developed based on a socio-ecological framework. We analyzed the data using deductive and inductive approaches. Results: Experts described a disconnect between awareness about and adherence to healthy diets among Indonesians. They highlighted a marked generational divide in food preferences between the younger population (<40y) and older population (40y+), due to the nutrition transition. Experts perceived that the nutrition transition has also resulted in more eating out, which promotes obesity, through the unhealthy menu offerings from restaurants. Experts also implied that traditional diets are no better than modern diets, due to unhealthy cooking practices, especially frying; suggesting that the combination of higher consumption of fast foods and unhealthy cooking practices may have worsened CVD risk factors in the population. Conclusion: Multi-disciplinary experts indicated that the nutrition transition has negatively impacted diets, health, and food environment in Indonesia. Our findings offer potential hypotheses that can be tested using quantitative approaches, to inform policy and the design of programs to reduce the adverse impacts of the nutrition transition in Indonesia.