Lower Perceived Neighborhood Collective Efficacy Indirectly Influences the Association Between Perceived Maternal Exposure to Community Violence and Household Food Insecurity.

BACKGROUND AND OBJECTIVES: Individuals of color and of low socioeconomic status are at greater risk of experiencing community violence and food insecurity, which are both influenced by neighborhood conditions. We evaluated neighborhood collective efficacy as a linkage between community violence exposure and household food insecurity. METHODS: Mothers from the Future of Families and Child Wellbeing Study who completed phone surveys when the child was 3 (time 1, T1) and 5 years old (time 2, T2) were included (n = 2068). A covariate-adjusted structural equation model estimated direct and indirect effects of community violence exposure on household food insecurity. A covariate-adjusted multiple mediator model estimated the indirect effects of the 2 neighborhood collective efficacy subscales (informal social control; social cohesion and trust). RESULTS: At T1, 40% of mothers reported community violence exposure; 15% experienced food insecurity at T2. Mean neighborhood collective efficacy (range 1-5) at T1 was 2.44 (SD = 0.94). Neighborhood collective efficacy indirectly influenced the association between community violence exposure and food insecurity (indirect effect = 0.022, 95% CI = 0.007 to 0.040). Only social cohesion and trust contributed independent variance to the indirect effect model (indirect effect = 0.028, 95% CI = 0.001 to 0.056). CONCLUSIONS: Community-based efforts to reduce household food insecurity should emphasize building social cohesion and trust in communities experiencing violence.

Feasibility of Delivering an on-Campus Food Distribution Program in a Community College Setting: A Mixed Methods Sequential Explanatory Investigation.

Despite community college students experiencing food insecurity there has been a dearth of research conducted on the feasibility of providing a program designed to increase access to fruits and vegetables among community colleges. This study used a mixed methods sequential explanatory design to examine the feasibility of delivering an on-campus food distribution program (FDP) to community college students and to examine the association between FDP and food insecurity and dietary intake. The study also explored the student's experiences related to barriers and facilitators of program utilization. In phase one, the FDP occurred for eight months and students could attend twice per month, receiving up to 60 pounds of food per visit. Online questionnaires were used to collect students' food security and dietary intake. Among the 1000 students offered the FDP, 495 students enrolled, with 329 students (66.5%) attending ≥ 1. Average attendance = 3.27 (SD = 3.08) [Range = 1-16] distributions. The FDP did not reduce food insecurity nor improve dietary intake. In phase two, a subsample of students (n = 36) discussed their FDP experiences through focus groups revealing three barriers limiting program utilization: program design and organization, personal schedule and transportation, and program abuse by other attendees. Facilitators to greater program utilization included: the type of food distributed and welcoming environment, along with allowing another designated individual to collect food. To maximize program use, it is suggested that reported barriers be addressed, which might positively influence food insecurity and dietary intake.

Parenting stress mediates the longitudinal effect of maternal depression on child anxiety/depressive symptoms.

BACKGROUND: Evidence is lacking for the longitudinal bidirectional relationship between maternal depression and child anxiety/depressive symptoms through pre-school to adolescence and regarding parenting stress as having a mediating effect on this association. METHODS: We performed a secondary analysis of data from the Fragile Families and Child Well-being Study (n = 1,446 child-mother dyads in 20 main U.S. cities) collected at baseline, Year-5 (T1), Year-9 (T2) and Year-15 (T3) (from 1998 to 2017). Maternal depression, child anxiety/depressive symptoms and parenting stress were assessed at three time points (T1-T3). The associations were evaluated using autoregressive cross-lagged panel models. RESULTS: Cross-lagged models indicated that 1) maternal depression significantly predicted subsequent higher child anxiety/depressive symptoms across all time points, and 2) greater child anxiety/depressive symptoms significantly predicted subsequent maternal depression across all time points. Furthermore, T1 maternal depression was indirectly associated with T3 child anxiety/depressive symptoms via T2 parenting stress [b = 0.010 (SE=0.004), p = 0.017]. However, T2 parenting stress did not significantly mediate the association between T1 child anxiety/depressive symptoms and T3 maternal depression [b = 0.004 (SE=0.004), p = 0.256]. LIMITATIONS: The FFCWS oversampled unmarried parents and had a higher proportion of socio-economically disadvantaged racial and ethnic minority families, limiting the generalizability of findings. CONCLUSIONS: Maternal depression is indirectly linked to child anxiety/depressive symptoms via parenting stress.

The mediating effect of parenting stress and couple relationship quality on the association between material hardship trajectories and maternal mental health status.

BACKGROUND: Household material hardships could have a negative impact on maternal mental health. Understanding mechanisms by which material hardship trajectories affect maternal depression and anxiety could aid health care professionals and researchers to design better interventions to improve mental health outcomes among mothers. METHODS: The study identified family-level mechanisms by which material hardship trajectories affect maternal depression and anxiety using Fragile Families and Child Wellbeing Study data (n = 1,645). Latent growth mixture modelling was used to identify latent classes of material hardship trajectories at Years-1, -3, and -5. Parenting stress and couple relationship quality was measured at Year-9. The outcome measures included maternal depression and generalized anxiety disorder (GAD) at Year-15 based on the Composite International Diagnostic Interview - Short Form. RESULTS: Parenting stress mediated the association between low-increasing hardship (b = 0.020, 95% confidence interval (CI):0.003, 0.043) and maternal depression. Parenting stress also mediated the association between high-increasing hardship (b = 0.043, 95% CI:0.004, 0.092), high decreasing hardship (b = 0.034, 95% CI=0.001, 0.072), and low-increasing (b = 0.034, 95% CI:0.007, 0.066) and maternal GAD. In all models, current material hardship was directly related to maternal depression (b = 0.188, 95% CI:0.134, 0.242) and GAD (b = 0.174, 95% CI:0.091, 0.239). LIMITATIONS: Study results need to be interpreted with caution as the FFCWS oversampled non-marital births as part of the original study design. CONCLUSIONS: While current material hardship appears to be more related to maternal mental health, prior material hardship experiences contribute to greater parenting stress which places mothers at risk for experiencing depression and GAD later on.

Development and Validation of a Questionnaire to Assess Barriers and Facilitators to Physical Activity among Hispanic Youth.

INTRODUCTION: The objective of this study was to develop and validate a questionnaire to better understand barriers and facilitators to physical activity among low-income, Hispanic youth. METHODS: Low-income Hispanic middle and high school students were recruited to participate in this study from a public charter school district in Houston, TX. Questionnaire development and psychometric validation included scale development and question pretesting, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), construct validity, and test-retest reliability of the scales. RESULTS: EFA resulted in three subscales for the Barriers to Youth Physical Activity (BYPA) scale: competing interests, environmental interests, and social barriers. CFA suggested that this three-factor model fit data adequately after removing two items that had high loading on all three factors. The BYPA subscales were internally consistent and stable. All three BYPA subscale scores were negatively correlated with self-reported physical activity. EFA for the facilitators to youth physical activity (FYPA) scale resulted in three subscales: enjoyment, family support, and socialization. CFA suggested that this three-factor model fit data adequately after removing one item that had high loading on all three factors. The FYPA subscales were internally consistent and stable. All three FYPA subscale scores were significantly positively correlated with physical activity. CONCLUSIONS: The development and validation of the BYPA and FYPA scales resulted in a total of six valid subscales for assessing barriers and facilitators to physical activity among low-income, Hispanic youth. The developed subscales have the potential to assist future efforts in designing physical activity interventions to better address disparities in physical activity levels among this population.

Risk of Excess and Inadequate Gestational Weight Gain among Hispanic Women: Effects of Immigration Generational Status.

There is a dearth of information on the risk of inadequate and excess gestational weight gain (GWG) among different generations of Hispanic women in the United States. Therefore, the objective of this study was to understand the relationship of GWG and immigration across three generations of Hispanic women. The study was conducted using data from National Longitudinal Survey of Youth 1979 (NLSY79). The study sample included 580 (unweighted count) women (148 first-generation, 117 second-generation, and 315 third-/higher-generation). Sociodemographic and immigration data were extracted from the main NLSY79 survey, and pregnancy data were extracted from the child/young adult survey following the biological children born to women in NLSY79. Covariate adjusted weighted logistic regression models were conducted to assess the risk of inadequate and excess GWG among the groups. Average total GWG was 14.98 kg, 23% had inadequate GWG, and 50% had excess GWG. After controlling for the covariates, there was no difference in the risk of inadequate GWG between the three generations. First-generation women (OR = 0.47, p = 0.039) and third-/higher-generation women (OR = 0.39, p = 0.004) had significantly lower risk of excess GWG compared to second-generation women. It is important to recognize the generational status of Hispanic women as a risk factor for excess GWG.

Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness.

Traditionally, intrapersonal characteristics (distress tolerance) and interpersonal characteristics (social support) have been studied separately rather than simultaneously. In the current study, we address this gap by simultaneously examining these characteristics as potential indirect associations linking established urban stress-depression and urban stress-Post-Traumatic Stress Disorder (PTSD) relationships. Adults experiencing homelessness were recruited from six homeless shelters in Oklahoma City (n = 567). Participants self-reported urban life stress (Urban Life Stress Scale), distress tolerance (Distress Tolerance Scale), social support (Interpersonal Support Evaluation List 12), major depressive disorder (Patient Health Questionnaire-8), and PTSD symptoms (Primary Care Post-Traumatic Stress Disorder screener). Covariate-adjusted structural equation models indicated a significant indirect effect of distress tolerance on the urban stress-depression (b = 0.101, 95% CI = 0.061, 0.147) and urban stress-PTSD (b = 0.065, 95% CI = 0.023, 0.112) relationships. Additionally, a significant indirect effect of social support on the urban stress-depression (b = 0.091, 95% CI = 0.053, 0.133) and urban stress-PTSD relationships (b = 0.043, 95% CI = 0.006, 0.082) was evident. Further, both the urban stress-depression (b = 0.022, 95% CI = 0.011, 0.037) and urban stress-PTSD relationships (b = 0.014, 95% CI = 0.005, 0.026) were associated indirectly through social support to distress tolerance. Interventions that aim to increase social support may also increase distress tolerance skills and indirectly reduce depressive and PTSD symptoms in the context of urban stress among adults experiencing homelessness.

Economic hardship and child intake of foods high in saturated fats and added sugars: the mediating role of parenting stress among high-risk families.

OBJECTIVE: Economic hardship (EH) may link to poorer child diet, however whether this association is due to resource limitations or effects on family functioning is unknown. This study examines whether parenting stress mediates the association between EH and child consumption of foods high in saturated fats and added sugars (SFAS). DESIGN: Data were collected from the Fragile Families and Child Wellbeing study. EH was assessed using eight items collected when children were between 1-9 years old. Mothers reported parenting stress and frequency of child consumption of high SFAS foods when children were 9 years old. Latent growth curve modelling (LGCM) and structural equation modelling tested direct associations between the starting level/rate of change in EH and high SFAS food consumption, and parenting stress as a mediator of the association. SETTING: Twenty US cities. PARTICIPANTS: Mothers/children (n 3846) followed birth through age 9 years, oversampled 'high-risk', unmarried mothers. RESULTS: LGCM indicated a curvilinear trend in EH from ages 1-9, with steeper increases from ages 3-9 years. EH did not directly predict the frequency of high SFAS foods. Average EH at 3 and 5 years and change in EH from ages 1-9 predicted higher parenting stress, which in turn predicted more frequent consumption of high SFAS foods. CONCLUSIONS: Findings suggest it may be important to consider parenting stress in early prevention efforts given potential lasting effects of early life EH on child consumption of high SFAS foods. Future research should explore how supports and resources may buffer effects of EH-related stress on parents and children.

Quality of Life: The Primary Goal of Lifestyle Intervention.

In much of lifestyle medicine, health-related quality of life (HRQoL) is a primary focus with the assumption that symptom reduction increases quality of life (QoL) in a more global sense. Lifestyle medicine research has shown that reducing symptoms increases the likelihood that QoL is improved. However, little information is available as to the impact of interventions when they are not effective in creating the desired healthy outcomes. It is possible that some lifestyle interventions have a negative impact on QoL, especially when a patient is not "successful" in reducing their symptomatology. Considering QoL from a broader perspective as an outcome in combination with traditional health outcomes may improve provider-patient rapport and empower patients to provide feedback on treatment, which, in turn, may improve overall treatment.

Stability and Change in Early Life Economic Hardship Trajectories and the Role of Sex in Predicting Adolescent Overweight/Obesity.

There is evidence that poverty is related to adverse child health outcomes. Yet, evidence is lacking on how economic hardship experiences during early childhood are related to adolescent obesity, how the relationship may differ by child sex, in addition to the potential child and maternal behavioral factors that link economic hardship and adolescent obesity. The purpose of the current study was to address this gap by using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 1814). The analytic sample included 50.5% girls, 20% experiencing overweight status, and 19% experiencing obesity. Majority of the adolescents were born to non-Hispanic black (49%), U.S. born (86%), married/cohabitating mothers (61%) with high school or greater level of education (75%). The economic hardship trajectory classes were determined using the latent growth mixture modeling approach and supported a 4-class trajectory model, with 5% of the adolescents in the high-increasing economic hardship trajectory class. The children in the high-increasing economic hardship class had increased odds of developing overweight/obesity in adolescence compared to those in low-stable class. This association was significantly moderated by child sex (i.e., relationship was significant for adolescent boys). Parenting stress and child snacking behaviors did not significantly mediate the association between economic hardship classes and overweight/obesity. Economic hardships that increase through early childhood need to be recognized as an obesity risk factor particularly for adolescent boys.

Association of Problematic Alcohol Use and Food Insecurity among Homeless Men and Women.

Food insecurity results from unreliable access to affordable and nutritious food. Homeless adults are particularly vulnerable to both food insecurity and problematic alcohol use. The current study examined the link between problematic alcohol use and food insecurity among homeless adults. Participants (N = 528; 62.7% men; Mage = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Problematic alcohol use was measured using the Alcohol Quantity and Frequency Questionnaire and the Patient Health Questionnaire. The latter used DSM-IV diagnostic criteria to assess probable alcohol use dependence/abuse. Heavy drinking was considered >7 drinks (women) and >14 drinks (men) per week. Food insecurity was measured with the USDA Food Security Scale-Short Form. The link between alcohol problems and food insecurity was examined with logistic regression analyses controlling for sex, age, education, income, and months homeless. Overall, 28.4% of the sample had probable alcohol dependence, 25% were heavy drinkers, and 78.4% were food insecure. Probable alcohol dependence and heavy drinking were correlated at 0.53 (p < 0.001). Results indicated that heavy drinking (OR = 2.12, CI.95 = 1.21, 3.73) and probable alcohol dependence/abuse (OR = 2.72, CI.95 = 1.55, 4.77) were each associated with increased odds of food insecurity. Food insecurity and problematic alcohol use are major issues among homeless populations; this study suggests they are associated. Future research is needed to shed light on potential causal mechanisms and on whether alcohol may take precedence over eating or food purchases.

Cumulative Risk Factors Associated with Food Insecurity among Adults who Experience Homelessness.

INTRODUCTION: There is a dearth of research on the determinants of food insecurity among adults who experience homelessness. According to cumulative risk theory, it is the accumulation of risk factors that places individuals in jeopardy for negative health consequences. Building on the cumulative risk theory, domain specific indices were created to examine the relationship between four cumulative risk factors and food insecurity among adults who experience homelessness. METHODS: Adult participants were recruited from six-area shelters in Oklahoma City (N = 565) during July - August 2016. Participants who affirmatively responded to two-six items of the six-item USDA Food Security Scale-Short form were categorized as food insecure. Four indices of cumulative risk were created based on affirmative survey responses: poor health & risky health behaviors index, personal and sexual victimization index, household disruption, and financial strain. Covariate-adjusted logistic regression models predicted the odds of adults experiencing food insecurity. RESULTS: Seventy-eight percent of the sample experienced food insecurity. Higher scores for the poor health and risky health behaviors index predicted higher odds of experiencing food insecurity (OR = 1.80, CI: 1.51 - 2.14). Higher scores for the personal and sexual victimization index predicted higher odds of experiencing food insecurity (OR = 1.57, CI: 1.20 - 2.04). CONCLUSION: To facilitate food security among adults experiencing homelessness, shelters and community-based programs need to consider homelessness and food insecurity to be multi-faceted public health problems that are inter-related.

The Importance of Language in Behavior Change.

Communication between health care providers and patients is important for behavioral treatment in lifestyle medicine. Ineffective communication can lead to patient dissatisfaction, demotivation, and discontinuation of treatment. It is important for health care providers to understand their biases, praise patients' behaviors rather than health outcomes, and use language to prevent dichotomous thinking. These strategies may lead to sustained lifestyle behavior changes and better treatment outcomes among patients.

Fruit and vegetable consumption and emotional distress tolerance as potential links between food insecurity and poor physical and mental health among homeless adults.

Food insecurity is associated with mental health outcomes among adults experiencing homelessness. Different theoretical explanations have emerged to account for the negative health outcomes among vulnerable populations. The neomaterial theoretical perspective suggests that nutritional deficiencies from experiencing food insecurity are related to negative health outcomes. Whereas, the psychosocial theoretical perspective indicates that perceived disadvantages or inability to cope emotionally (i.e. lower distress tolerance) from food insecurity leads to adverse health outcomes. Building on these theoretical perspectives, the purpose of the study was to determine whether fruit and vegetable consumption (as a measure of diet quality) or emotional distress tolerance act as potential links between food insecurity and poor physical and mental health among adults experiencing homelessness. Adults were recruited from six area shelters in Oklahoma City (N = 566) during July-August 2016. Data was collected via a self-administered questionnaire on a tablet computer. Self-rated poor health, depression, and post-traumatic stress disorder (PTSD) were regressed on food insecurity using logistic regressions. Indirect effects were assessed using bootstrapping methods outlined by Preacher and Hayes. In covariate-adjusted models, lower levels of distress tolerance, but not fruit and vegetable consumption, partially mediated the association between food insecurity and poor health (ß = 0.28, [0.14, 0.44]), depression (ß = 0.56, [0.33, 0.88]), and PTSD (ß = 0.39, [0.22, 0.60]). Results suggest that experiencing food insecurity may lower the ability to withstand emotional distress and consequently contributes to negative health outcomes.