Association between Socioeconomic Factors, Food Insecurity, and Dietary Patterns of Adolescents: A Latent Class Analysis.

Socioeconomic factors and food insecurity play a fundamental role in the food choices of adolescents, and in addition to influencing access to food, they also have significant effects on dietary patterns. The objectives of this study were to identify the dietary patterns of adolescents through the application of latent class analysis and to evaluate their association with socioeconomic variables and food insecurity. This cross-sectional study was conducted with adolescents aged between 11 and 17 years from public schools. Latent class analysis was used to identify the dietary patterns. Associations between socioeconomic factors, food insecurity and dietary patterns were assessed using multinomial logistic regression (odds ratio (OR); 95% confidence interval (CI)). Among the 1215 participants in the study, four dietary patterns were identified: "Mixed", "Low consumption", "Prudent" and "Diverse". A "Diverse" dietary pattern was associated with a lower economic stratum (OR:2.02; CI:1.26-3.24). There was no association between food insecurity and identified dietary patterns. These results highlight the importance of promoting healthy eating in this age group at all socioeconomic levels, especially the lowest level.

The association between intimate partner domestic violence and the food security status of poor families in Brazil.

OBJECTIVE: To assess the association between physical intimate partner violence and household food security within households with schoolchildren. DESIGN: Cross-sectional study. SETTING: Salvador, Bahia, north-eastern Brazil. SUBJECTS: The study was conducted in 1019 households with students. Violence between couples was evaluated using the Portuguese version of the revised Conflict Tactics Scales (CTS2), previously adapted and validated for use in Brazil. The Brazilian Food Insecurity Scale (BFIS) was used to identify food insecurity. We also obtained socio-economic information for each participant. We used multivariate Poisson regression to assess the associations of interest. RESULTS: According to the results of the BFIS, 62·5% of the households were found to experience food insecurity, including 19·5% moderate food insecurity and 6·5% severe food insecurity. The prevalence of minor physical violence was 9·6% (95% CI 7·8, 11·4%) and of severe physical violence was 4·7% (95% CI 3·4, 6·0%) among the couples. In the final multivariate model, it was found that couples reporting minor (prevalence ratio=1·23; 95% CI 1·12, 1·35) and severe (prevalence ratio=1·16; 95% CI 1·00, 1·34) physical violence were more likely to be experiencing household food insecurity, compared with those not reporting physical violence. CONCLUSIONS: Physical intimate partner violence was associated with food insecurity of households. The present study brings new data to the subject of the role of violence in the context of food insecurity.

Effectiveness of the Brazilian Conditional Cash Transfer Program--Bolsa Alimentação--on the variation of linear and ponderal increment in children from northeast of Brazil.

BACKGROUND: Social programs can improve the conditions required for families provide sufficient care and attention for an adequate health and nutrition. OBJECTIVE: This study evaluates the effectiveness of the Brazilian's conditional cash transfer program--Bolsa Alimentacao (PBA) on children anthropometric status. METHODS: A cohort of 1847 children, followed for 12 months: 1615 PBA children; 232 non-PBA. There were 316 (14.6%) missing children during the study. A quasi-experimental study adopting the before-after strategy was applied and the effectiveness approach was used to assess the impact of the program on children nutritional status. Multilevel analysis with three levels was used in the statistical analysis. The mean increment variations of height-for-age and weight-for-age were the outcome variables and the participation in the PBA was the exposition. Four participation groups were established: children not exposed to the program (internal control group); exposed to the program throughout the 12 months, exposed to the program only in the last 6 months; and exposed to the program only in the first 6 months. Repeated measures were obtained at baseline and at 12 months. RESULTS: It was found that the exposure to the program was associated to a mean variation in weight-for-age of 0.34 Z-score (IC = 0.04; 0.63) and height-for-age of 0.38 (IC = 0.05; 0.70) for children who were regular program beneficiaries during the follow-up. The exposure to the program in other periods was not statistically associated with a mean variation in the indicators. CONCLUSIONS: Cash transfers direct to the family were associated to anthropometric deficits reduction in childhood.

Food and nutrition insecurity: a marker of vulnerability to asthma symptoms.

OBJECTIVE: To evaluate the association between food and nutrition insecurity and asthma in children from Latin America. DESIGN: Cross-sectional study. SETTING: São Francisco do Conde, Bahia, north-eastern Brazil. SUBJECTS: The study included 1307 children aged 6-12 years from public elementary schools. Asthma symptoms were collected using a questionnaire that was translated and adapted from the International Study of Asthma and Allergies in Childhood, phase III. The diagnosis of asthma was determined based on reports of wheezing in the previous 12 months. The Brazilian Food Insecurity Scale was used to identify food insecurity. We also obtained demographic, socio-economic and anthropometric information for each participant. We used multivariate logistic regression analyses to assess the associations of interest. RESULTS: Of the children surveyed, 10·4% had a history of wheezing and 64·5% had some degree of food and nutrition insecurity. We found a positive dose-response relationship and statistically significant associations of asthma with moderate (OR = 1·71, 95% CI 1·01, 2·89) and severe (OR = 2·51, 95% CI 1·28, 4·93) food and nutrition insecurity. CONCLUSIONS: The results show that moderate and severe food and nutrition insecurity are markers of vulnerability to wheezing. It is important to note that the results of studies in this field have potential implications for social policies that promote food security. Further studies to identify the mechanisms involved in the relationship between food and nutrition insecurity and asthma are needed.

[Street food and intervention: strategies and proposals to the developing world]. / Comida de rua e intervenção: estratégias e propostas para o mundo em desenvolvimento.

The objective of this study is to analyze the intervention strategies presented for the street food segment, based on national and international studies and reports. According to the literature, it is observed a broad character of these intervention strategies, including actions directed to sellers, consumers, public human resources and to the development of appropriate technologies. In relation to the vendors, the strategies highlight the necessity of the activity regulation, the establishment of sanitary regulations, guidelines or codes to the activity as well as training of food handlers and vendors. To consumers, the actions comprise mainly the implementation of educational programs. At public administration sphere the strategies turn to human resources capacitating. Considering the appropriate technologies two possibilities are identified: the construction of specialized street food centers and the improvement of existing stalls. One can conclude that given the increase in sales of street food and the potential sanitary risks inherent to this sector, studies point to strategies to organize this segment, which can subsidize the development of social policies for this area in Brazil.

[Inequality, poverty, and childhood health and nutritional conditions in Northeast Brazil]. / Desigualdade, pobreza e condições de saúde e nutrição na infância no Nordeste brasileiro.

This cross-sectional study analyzes the relationship between gradients of social inequalities and the household environment and health and nutritional conditions among 2,001 preschool children in ten counties (municipalities) in the State of Bahia, Brazil. The analysis used multinomial multivariate logistic regression. Children in the middle and lower tertiles on the poverty scale had significant and increasing odds of living in a household headed by a woman, an unemployed father, a mother with

[Evaluation of public policies for food security and hunger control in Brazil, 1995-2002: 1--Methodological framework]. / Avaliação de políticas públicas de segurança alimentar e combate à fome no período de 1995-2002: 1--Abordagem metodológica.

The authors describe the adaptation and application of a multidimensional methodology based on structure-process-outcome for evaluating food security and hunger control programs. According to the proposal, study of the structure dimension analyzes the programs' material and discursive instruments; the process dimension focuses on the activities and interventions; and the outcome dimension includes coverage, targeting, and social control, and also potentially the effects of the interventions on the beneficiaries' food security and nutrition. The methodology was used to evaluate programs implemented in Brazil from 1995 to 2002. A case study was also done including 45 municipalities in the State of Bahia, involving documental research, interviews with key informants, and a household survey including 1,750 low-income families in the rural area and 760 in the capital city. The results are expected to contribute to the discussion on facilitating factors and obstacles at the local level for the implementation of such programs, and to methodological development in the field of food security, nutrition, and hunger control policies.

Methodological approach to a multidimensional evaluation of food and nutrition policies.

Recommendations arising from global conferences and summits, expressed the need to formulate and implement public policies to improve household food security. In the context of maximizing benefits given available resources, comprehensive evaluations of the nutrition policies and programs are needed. One obstacle to overcome was a clear definition of terminology; the words efficiency, effectiveness, efficacy and impact, widely used in the context of program evaluation, are sometimes interchanged and there is no consensus about their precise definition. Another approach to health evaluation is based in the paradigm structure-process-outcome. The level structure contemplated the installations, resources, instruments (physical and discursive), as well as the technical bureaucratic organizational structures. Process encompassed the whole set of intervention activities developed, whereas the dimension of outcome comprised the effects of interventions on the health and nutrition of beneficiaries. Each of the three dimensions constitutes a continuum in the evaluation procedure: the structure only fulfills its purposes if the processes are adequate and conversely, processes cannot alone supersede structural limitations. Moreover, all the three dimensions only reach their ultimate objectives through the completion of outcomes. The methodology proposed here has been tested in the case of Bahia, Northeast Brazil, and it was found to be adequate for this type of analysis. We hope this approach of a comprehensive multidimensional evaluation, constitutes an effective contribution for program planners and program managers, in particular with regard to the obstacles detected, some of which can surely be overcome.