Development and Validation of an Abbreviated Child and Adult Food Security Scale for Use in Clinical and Research Settings in the United States.

BACKGROUND: Food insecurity (FI) prevalence was consistently >10% over the past 20 years, indicating chronic economic hardship. Recession periods exacerbate already high prevalence of FI, reflecting acute economic hardship. To monitor FI and respond quickly to changes in prevalence, an abbreviated food security scale measuring presence and severity of household FI in adults and children is needed. OBJECTIVE: Our aim was to develop an abbreviated, sensitive, specific, and valid food security scale to identify severity levels of FI in households with children. DESIGN: Cross-sectional and longitudinal survey data were analyzed for years 1998 to 2022. PARTICIPANTS/SETTING: Participants were racially diverse primary caregivers of 69,040 index children younger than 4 years accessing health care in 5 US cities. STATISTICAL ANALYSES PERFORMED: Sensitivity, specificity, positive and negative predictive values, accuracy, and area under the receiver operator curve were used to test combinations of questions for the most effective abbreviated scale to assess levels of severity of adult and child FI compared with the Household Food Security Survey Module. Adjusted logistic regression models assessed convergent validity between the Abbreviated Child and Adult Food Security Scale (ACAFSS) and health measures. McNemar tests examined the ACAFSS performance in times of acute economic hardship. RESULTS: The ACAFSS exhibited 91.2% sensitivity; 99.6% specificity; 98.3% and 97.6% positive and negative predictive values, respectively; 97.7% accuracy; and a 99.6% area under the receiver operator curve, while showing high convergent validity. CONCLUSIONS: The ACAFSS is highly sensitive, specific, and valid for detecting severity levels of FI among racially diverse households with children. The ACAFSS is recommended as a stand-alone scale or a follow-up scale after households with children screen positive for FI risk. The ACAFSS is also recommended for planning interventions and evaluating their effects not only on the binary categories of food security and FI, but also on changes in levels of severity, especially when rapid decision making is crucial.

Child Care Feeding Programs Associated With Food Security and Health for Young Children From Families With Low Incomes.

BACKGROUND: The Child and Adult Care Food Program is the primary national program that enables child-care settings to provide healthy meals for children. Associations between Child and Adult Care Food Program participation and child health and development and health care utilization are understudied. OBJECTIVE: To assess associations between children's health, development, health care utilization and food security by meal source (child-care-provided vs parent-provided) among children from low-income families with a child care subsidy attending child-care in settings likely eligible to participate in Child and Adult Care Food Programs. DESIGN: The study used repeat cross-sectional surveys (new sample at successive time points) conducted year-round. PARTICIPANTS AND SETTING: Primary caregivers of 3,084 young children accessing emergency departments or primary care in Baltimore, MD; Boston, MA; Little Rock, AR; Minneapolis, MN; and Philadelphia, PA, were interviewed between 2010 and 2020. The sample was limited to children aged 13 to 48 months, receiving a child care subsidy and attending child-care centers or family child-care homes ≥20 hours per week. MAIN OUTCOME MEASURES: Outcomes included household and child food security; child health, growth, and developmental risk; and admission to the hospital on the day of the emergency department visit. STATISTICAL ANALYSES: Meal source and participant characteristics were analyzed using χ2 tests; associations of outcomes with parent-provided meals were analyzed with adjusted logistic regression. RESULTS: The majority of children had child-care-provided meals (87.2% child-care-provided vs 12.8% parent-provided). Compared with children with parent-provided meals, children with child-care-provided meals had lower adjusted odds of living in a food-insecure household (adjusted odds ratio 0.70, 95% CI 0.55 to 0.88), being in fair or poor health (adjusted odds ratio 0.61, 95% CI 0.46 to 0.81), or hospital admission from the emergency department (adjusted odds ratio 0.59, 95% CI 0.41 to 0.83), with no differences in growth or developmental risk. CONCLUSIONS: Compared with meals provided from home, child-care-provided meals likely supported by the Child and Adult Care Food Program are related to food security, early childhood health, and reduced hospital admissions from an emergency department among low-income families with young children.

Type of Child Care Setting Is Associated With Child Care Constraints and Food Insecurity Among Families With Low-Incomes.

OBJECTIVE: High quality child care positively affects long-term development in children and is a necessary support for parents who work or are in school. We assessed the association between child care setting and parents' report of difficulties with ability to work and/or further their education ("child care constraints") or material hardships among families with low incomes. METHODS: Cross-sectional data were analyzed from families in Minneapolis, MN with children aged six weeks to 48 months in child care from 2004 to 2017. Associations between child care setting (formal, informal relative, informal non-relative) and child care constraints or material hardships (household/child food insecurity, housing instability, energy instability) were examined. RESULTS: Among 1580 families, 73.8% used informal care. Child care subsidy and public assistance program participation were higher among families utilizing formal care. Compared to formal care, families using informal relative or non-relative care had 2.44 and 4.18 greater adjusted odds of child care constraints, respectively. Families with children in informal non-relative care had 1.51 greater adjusted odds of household food insecurity. There were no statistically significant associations between informal relative care and household or child food insecurity, and no associations between child care setting and housing instability or energy insecurity. CONCLUSIONS: Informal care settings-relative and non-relative-were associated with child care constraints, and informal non-relative care with household food insecurity. Investment to expand equitable access to affordable, high-quality child care is necessary to enable parents to pursue desired employment and education and reduce food insecurity.

Critical windows of susceptibility for the effects of prenatal exposure to heat and heat variability on gestational growth.

BACKGROUND: Studies have shown that prenatal heat exposure may impact fetal growth, but few studies have examined the critical windows of susceptibility. As extreme heat events and within season temperature variability is expected to increase in frequency, it is important to understand how this may impact gestational growth. OBJECTIVES: We investigated associations between various measures of weekly prenatal heat exposure (mean and standard deviation (SD) of temperature and heat index (HI), derived using temperature in °C and dew point) and term birthweight or odds of being born small for gestational age (SGA) to identify critical windows of susceptibility. METHODS: We analyzed data from mother-child dyads (n = 4442) in the Boston-based Children's HealthWatch cohort. Birthweights were collected from survey data and electronic health records. Daily temperature and HI values were obtained from 800 m gridded spatial climate datasets aggregated by the PRISM Climate Group. Distributed lag-nonlinear models were used to assess the effect of the four weekly heat metrics on measures of gestational growth (birthweight, SGA, and birthweight z-scores). Analyses were stratified by child sex and maternal homelessness status during pregnancy. RESULTS: HI variability was significantly associated with decreased term birthweight during gestational weeks 10-29 and with SGA for weeks 9-26. Cumulative effects for these time periods were -287.4 g (95% CI: -474.1 g, -100.8 g for birthweight and 4.7 (95% CI: 1.6, 14.1) for SGA. Temperature variability was also significantly associated with decreased birthweight between weeks 15 and 26. The effects for mean heat measures on term birthweight and SGA were not significant for any gestational week. Stratification by sex revealed a significant effect on term birthweight in females between weeks 23-28 and in males between weeks 9-26. Strongest effects of HI variability on term birthweight were found in children of mothers who experienced homelessness during pregnancy. Weekly HI variability was the heat metric most strongly associated with measures of gestational growth. The effects observed were largest in males and those who experienced homelessness during pregnancy. DISCUSSION: Given the impact of heat variability on birthweight and risk of SGA, it is important for future heat warnings to incorporate measure of heat index and temperature variability.

A insegurança alimentar pela voz de adolescentes participantes do Programa Bolsa Família / Food insecurity through the voice of adolescents participating in the Bolsa Família Program / La inseguridad alimentaria a través de las voces de adolescentes participantes del Programa Bolsa Familia

Resumo O trabalho busca conhecer a percepção de adolescentes, participantes do Programa Bolsa Família (PBF), sobre insegurança alimentar (IA). Trata-se de estudo de abordagem qualitativa. O corpus consiste em entrevistas com dez adolescentes e seus responsáveis. Os resultados foram analisados por meio da técnica de análise de conteúdo. Foram estabelecidas quatro categorias de análise: "A fome não é só a vontade de comer"; "O fantasma da fome"; "Um por todos e todos por um"; "Estamos seguros?" De maneira geral, os adolescentes percebem que a quantidade e variedade de alimentos mudam durante o mês e que o acesso a alimentos como frutas e carne é difícil. A preocupação com a possibilidade de o alimento faltar está presente na fala de todos os adolescentes entrevistados e se intensifica entre aqueles que vivenciaram a experiência de fome na infância. Em função disso, os adolescentes desenvolvem estratégias para o alívio da IA, para si mesmos e para suas famílias. No entanto, as responsáveis pelos adolescentes não consideram que seus filhos realmente se preocupam com a possibilidade de faltar alimentos no domicílio. Observou-se que os adolescentes percebem a situação de insegurança alimentar no domicílio e são capazes de responder de forma autônoma sobre essa situação.

Abstract Objective: To understand the perception of adolescents, participants of the Bolsa Família Program (PBF), about Food Insecurity (FI). Methods: This is a study with a qualitative approach. The corpus consists of interviews with 10 adolescents and their caregivers. Results were analyzed using Content Analysis (CA) technique. Results: Four categories were established: "Hunger is not just the desire to eat", "The ghost of hunger", "One for all and all for one", and "Are we safe?". Overall, adolescents perceive the amount and variety of food changes throughout the month and that access to meat and fruits is difficult. The concern with the possibility of running out of food permeates the interviewees' statements and intensifies among those who experienced hunger during childhood. As a result, many statements reveal the strategies developed by adolescents to alleviate FI for themselves and their families. However, statements also points to the fact that caregivers do not consider their children are truly concerned with the possibility of running out of food at home. Conclusion: Adolescents perceive food insecurity in the home and are able to respond autonomously to the situation.

Resumen Objetivo: Conocer la percepción de las y los adolescentes participantes del Programa Bolsa Familia (PBF) sobre la inseguridad alimentaria (IA). Métodos: Se trata de un estudio con abordaje cualitativo. El corpus consta de entrevistas a diez adolescentes y a sus tutores. Los resultados se analizaron mediante la técnica de análisis de contenido (CA). Resultados: Se establecieron cuatro categorías de análisis: El hambre no es solo el deseo de comer; El fantasma del hambre; Uno para todos y todos para uno, y ¿Estamos a salvo?. En general, las y los adolescentes perciben que la cantidad y la variedad de alimentos cambia durante el mes y que se les dificulta el acceso a carnes y frutas. La preocupación por la posibilidad de quedarse sin alimentos impregna sus declaraciones y se intensifica entre quienes pasaron hambre durante sus infancias. Como resultado, muchas afirmaciones revelan el desarrollo de estrategias para paliar la IA, para ellos y ellas mismas y para sus familias, pero señalan que sus tutores no consideran que sus hijos e hijas estén realmente preocupados por quedarse sin alimentos en el hogar. Conclusión: Los y las adolescentes perciben la situación de IA en el hogar y son capaces de responder de forma autónoma frente a ella.

[Validity of an instrument for screening households at risk of food insecurity in different strata of the Brazilian population]. / Validade do instrumento para triagem de domicílios em risco de insegurança alimentar em diversos estratos da população brasileira.

The absence of risk screening tools for food insecurity compromises the ability to assess, monitor, and provide immediate assistance to those in hunger, especially during emergencies such as the COVID-19 crisis. Hence, this study sought to test the validity of an instrument for Screening Households at Risk of Food Insecurity (TRIA) in different strata of the Brazilian population TRIA uses questions 2 and 4 of the Brazilian Food Insecurity Scale (EBIA), originally validated using data from the Brazilian National Survey of Demography and Health of Children and Women (PNDS 2006). In this study, using data from the Brazilian National Household Sample Survey (PNAD 2013), its reproducibility was tested by repeating the original combinatorial procedures, examining whether the parameters of sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative values (NPV) would result in the same arrangement of questions. Moreover, convergent validity was analyzed by comparing the strength of association between food insecurity and dietary variables using two binomial regression models (TRIA x EBIA). Results indicated that the combination of questions 2 and 4 performed best among the population strata studied, and presented optimal convergent validity. PPV and NPV adjusted for food insecurity prevalence in states ranged from 42.8% (Santa Catarina) to 87.6% (Amazonas) and 95.8% (Amazonas) to 99.5% (Santa Catarina), respectively. In conclusion, besides being reproducible, TRIA presented excellent validity parameters, especially among vulnerable groups. It can thus be used in care practice and as an instrument of food and nutritional surveillance in Brazil.

A ausência de instrumentos de triagem de risco para insegurança alimentar compromete a capacidade de avaliar, monitorar e ofertar assistência imediata a pessoas em situação de fome, especialmente durante emergências, como a crise da COVID-19. Assim, o objetivo deste estudo foi testar a validade do instrumento de Triagem para Risco de Insegurança Alimentar (TRIA), em diversos estratos da população brasileira. A TRIA é composta pelas questões 2 e 4 da Escala Brasileira de Insegurança Alimentar (EBIA), validada, originalmente, a partir de dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006). Neste estudo, utilizando dados da Pesquisa Nacional por Amostra de Domicílios (PNAD 2013), testou-se sua reprodutibilidade por meio da repetição dos procedimentos combinatórios originais, examinando se os parâmetros de sensibilidade, especificidade, acurácia e valores preditivos positivo (VPP) e negativo (VPN) resultariam no mesmo arranjo de questões. Ainda, analisou-se a validade convergente comparando a força de associação entre insegurança alimentar e variáveis alimentares por meio de dois modelos de regressão binomial (TRIA x EBIA). Os resultados indicaram que a combinação das questões 2 e 4 apresentou melhor desempenho entre os estratos populacionais estudados, além de ótima validade convergente. O VPP e VPN ajustado pela prevalência de insegurança alimentar nos estados variou de 42,8% (Santa Catarina) a 87,6% (Amazonas) e 95,8% (Amazonas) a 99,5% (Santa Catarina), respectivamente. Em conclusão, além de ser reprodutível, a TRIA apresentou excelentes parâmetros de validade, sobretudo em grupos vulnerabilizados. Assim, seu uso pode ser recomendado na prática assistencial e como instrumento de vigilância alimentar e nutricional no Brasil.

La ausencia de instrumentos de triaje de riesgo para la inseguridad alimentaria compromete la capacidad de evaluar, monitorear y brindar asistencia inmediata a las personas en situación de hambre, especialmente durante emergencias como la crisis de la COVID-19. Por lo tanto, el objetivo de este estudio fue probar la validez del instrumento de Triaje para Riesgo de Inseguridad Alimentaria (TRIA) en diferentes estratos de la población brasileña. El TRIA consta de las preguntas 2 y 4 de la Escala Brasileña de Inseguridad Alimentaria (EBIA), originalmente validada con base en datos de la Encuesta Nacional de Demografía y Salud de la Mujer y el Niño (PNDS 2006). En este estudio, utilizando datos de la Encuesta Nacional por Muestra de Domicilios (PNAD 2013), se probó su reproducibilidad repitiendo los procedimientos combinatorios originales, examinando si los parámetros de sensibilidad, especificidad, exactitud y valores predictivos positivos (VPP) y negativo (VPN) resultarían en el mismo arreglo de preguntas. Además, se analizó la validez convergente comparando la fuerza de asociación entre la inseguridad alimentaria y las variables alimentarias por medio de dos modelos de regresión binomial (TRIA x EBIA). Los resultados indicaron que la combinación de las preguntas 2 y 4 presentó el mejor desempeño entre los estratos poblacionales estudiados, además de excelente validez convergente. El VPP y el VPN ajustado por la prevalencia de inseguridad alimentaria en los estados osciló entre el 42,8% (Santa Catarina) y el 87,6% (Amazonas) y entre el 95,8% (Amazonas) y el 99,5% (Santa Catarina), respectivamente. En conclusión, además de ser reproducible, el TRIA presentó excelentes parámetros de validez, especialmente en grupos en situación de vulnerabilidad. Por lo tanto, se puede recomendar su uso en la práctica asistencial y como instrumento para la vigilancia alimentaria y nutricional en Brasil.

Factors associated with food insecurity among pregnant women assisted by Universal Health Care in Lavras - Minas Gerais State / Fatores associados à insegurança alimentar em gestantes atendidas na rede pública de saúde de Lavras - Minas Gerais

Abstract Objectives: to investigate sociodemographic and economic factors associated with food insecurity among pregnant women assisted by the universal healthcare network of Lavras, Minas Gerais. Methods: a cross-sectional study investigated socioeconomic and demographic, obstetric, and nutritional conditions experienced by pregnant women. Households in which pregnant women lived were classified as food secure or food insecure using the Brazilian Food Insecurity Scale. Prevalence estimates and prevalence ratios with 95% confidence intervals were generated to test for associations between food insecurity and several socioeconomic and demographic indicators using Poisson regression analysis. Results: among 173 pregnant women who participated in the study, 48% lived in households with some level of food insecurity. Adjusted models showed that pregnant women living in food-insecure households had higher prevalence ratios of lower education attainment (aPR = 1.43, CI95% = 1.07-1.91), woman being the head of the household (aPR = 1.39, CI95% = 1.02-1.87), having family monthly income lower than 1 ½ MW (aPR = 1.68, CI95% = 1.11-2.52) and participating in the government cash transfer program (aPR = 1.47, CI95% = 1.08-1.99). Conclusions: the high prevalence of food insecurity in pregnant women assisted by the public healthcare system was associated with structural social factors. Results of this study will contribute to develop an intersectoral health and nutrition policy in order to promote food security among marginalized communities and vulnerable populations, such as pregnant women.

Resumo Objetivos: investigar fatores sociodemográficos e econômicos associados à insegurança alimentar entre gestantes atendidas pelo sistema único de saúde de Lavras - Minas Gerais. Métodos: características socioeconômicas, demográficas, obstétricas e nutricionais de gestantes foram coletadas em estudo transversal. Os domicílios das gestantes foram classificados em segurança ou insegurança alimentar utilizando a Escala Brasileira de Insegurança Alimentar. Estimativas de prevalência e razão de prevalência com intervalos de confiança de 95%, testaram associações entre insegurança alimentar e indicadores socioeconômicos e demográficos utilizando modelos de Poisson. Resultados: entre as 173 gestantes participantes deste estudo, 48% viviam em domicílios com algum nível insegurança alimentar (IA). Modelos ajustados indicaram que gestantes em IAapresentaram maior prevalência de escolaridade inferior a oito anos de estudo (aRP = 1.39, IC95% = 1.07-1.91), ser chefe de família (aRP = 1.39, IC95% = 1.02-1.87), ter renda mensal inferior a 1½ salário mínimo (aRP = 1.68, IC95% =1.11-2.25), e ser participante do Bolsa Família (aRP = 1.47, IC95% = 1.08-1.99). Conclusão: a alta prevalência de insegurança alimentar em gestantes do sistema público de saúde de Lavras está associado a fatores socio-estruturais. Os resultados desta pesquisapoderão contribuir com o desenvolvimento de políticas intersetoriais de saúde e nutrição para a promoção da segurança alimentar entre comunidades marginalizadas e populações vulneráveis.

Postnatal exposure to PM2.5 and weight trajectories in early childhood.

BACKGROUND: Inconsistent evidence has assessed the impact of air pollution exposure on children's growth trajectories. We investigated the role of 90-day average postnatal fine particulate matter (PM2.5) exposures by estimating the magnitude of effects at different ages, and the change in child weight trajectory by categories of exposure. METHODS: We obtained weight values from electronic health records at each hospital visit (males = 1859, females = 1601) from birth to 6 years old children recruited into the Boston-based Children's HealthWatch cohort (2009-2014). We applied mixed models, adjusting for individual and maternal confounders using (1) varying-coefficient models allowing for smooth non-linear interaction between age and PM2.5, (2) factor-smooth interaction between age and PM2.5 quartiles. Additionally, we stratified by sex and low birthweight (LBW) status (≤2500 g). RESULTS: Using varying-coefficient models, we found that PM2.5 significantly modified the association between age and weight in males, with a positive association in children younger than 3 years and a negative association afterwards. In boys, for each 10 µg/m3 increase in PM2.5 we found a 2.6% increase (95% confidence interval = 0.8, 4.6) in weight at 1 year of age and a -0.6% (95% confidence interval = -3.9, 2.9) at 5 years. We found similar but smaller changes in females, and no differences comparing growth trajectories across quartiles of PM2.5. Most of the effects were in LBW children and null for normal birthweight children. CONCLUSIONS: This study suggests that medium-term postnatal PM2.5 may modify weight trajectories nonlinearly in young children, and that LBW babies are more susceptible than normal-weight infants.

Prenatal WIC Is Associated with Increased Birth Weight of Infants Born in the United States with Immigrant Mothers.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves health outcomes for participating mothers and children. Recent immigration policy changes increased chilling effects on WIC access and utilization. Associations between WIC participation and neonatal outcomes among infants born to immigrant parents-23% of all births in the United States-are understudied. OBJECTIVE: Our aim was to examine relationships between prenatal participation in WIC and birth weight among infants of income-eligible immigrant mothers. DESIGN: The study design was repeat cross-sectional in-person surveys. PARTICIPANTS/SETTING: Participants were 9,083 immigrant mothers of publicly insured or uninsured US-born children younger than 48 months accessing emergency departments or primary care in Baltimore, MD; Boston, MA; Little Rock, AR; Minneapolis, MN; and Philadelphia, PA interviewed from 2007 through 2017. MAIN OUTCOME MEASURES: Outcomes were mean birth weight (in grams) and low birth weight (<2,500 g). STATISTICAL ANALYSES: Multivariable linear regression assessed associations between prenatal WIC participation and mean birth weight; multivariable logistic regression examined association between prenatal WIC participation and low birth weight. RESULTS: Most of the immigrant mothers (84.6%) reported prenatal WIC participation. Maternal ethnicities were as follows: 67.4% were Latina, 27.0% were Black non-Latina, 2.2% were White non-Latina, and 3.5% were other/multiple races non-Latina. Infants of prenatal WIC-participant immigrant mothers had higher adjusted mean birth weight (3,231.1 g vs 3,149.8 g; P < .001) and lower adjusted odds of low birth weight (adjusted odds ratio 0.79, 95% CI 0.65 to 0.97; P = .02) compared with infants of nonparticipants. Associations were similar among groups when stratified by mother's length of stay in United States. CONCLUSIONS: Prenatal WIC participation for income-eligible immigrant mothers is associated with healthier birth weights among infants born in the United States, including for those who arrived most recently.

Validade do instrumento para triagem de domicílios em risco de insegurança alimentar em diversos estratos da população brasileira / Validity of an instrument for screening households at risk of food insecurity in different strata of the Brazilian population / Validez del instrumento de triaje de hogares en riesgo de inseguridad alimentaria en diferentes estratos de la población brasileña

A ausência de instrumentos de triagem de risco para insegurança alimentar compromete a capacidade de avaliar, monitorar e ofertar assistência imediata a pessoas em situação de fome, especialmente durante emergências, como a crise da COVID-19. Assim, o objetivo deste estudo foi testar a validade do instrumento de Triagem para Risco de Insegurança Alimentar (TRIA), em diversos estratos da população brasileira. A TRIA é composta pelas questões 2 e 4 da Escala Brasileira de Insegurança Alimentar (EBIA), validada, originalmente, a partir de dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006). Neste estudo, utilizando dados da Pesquisa Nacional por Amostra de Domicílios (PNAD 2013), testou-se sua reprodutibilidade por meio da repetição dos procedimentos combinatórios originais, examinando se os parâmetros de sensibilidade, especificidade, acurácia e valores preditivos positivo (VPP) e negativo (VPN) resultariam no mesmo arranjo de questões. Ainda, analisou-se a validade convergente comparando a força de associação entre insegurança alimentar e variáveis alimentares por meio de dois modelos de regressão binomial (TRIA x EBIA). Os resultados indicaram que a combinação das questões 2 e 4 apresentou melhor desempenho entre os estratos populacionais estudados, além de ótima validade convergente. O VPP e VPN ajustado pela prevalência de insegurança alimentar nos estados variou de 42,8% (Santa Catarina) a 87,6% (Amazonas) e 95,8% (Amazonas) a 99,5% (Santa Catarina), respectivamente. Em conclusão, além de ser reprodutível, a TRIA apresentou excelentes parâmetros de validade, sobretudo em grupos vulnerabilizados. Assim, seu uso pode ser recomendado na prática assistencial e como instrumento de vigilância alimentar e nutricional no Brasil.

The absence of risk screening tools for food insecurity compromises the ability to assess, monitor, and provide immediate assistance to those in hunger, especially during emergencies such as the COVID-19 crisis. Hence, this study sought to test the validity of an instrument for Screening Households at Risk of Food Insecurity (TRIA) in different strata of the Brazilian population TRIA uses questions 2 and 4 of the Brazilian Food Insecurity Scale (EBIA), originally validated using data from the Brazilian National Survey of Demography and Health of Children and Women (PNDS 2006). In this study, using data from the Brazilian National Household Sample Survey (PNAD 2013), its reproducibility was tested by repeating the original combinatorial procedures, examining whether the parameters of sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative values (NPV) would result in the same arrangement of questions. Moreover, convergent validity was analyzed by comparing the strength of association between food insecurity and dietary variables using two binomial regression models (TRIA x EBIA). Results indicated that the combination of questions 2 and 4 performed best among the population strata studied, and presented optimal convergent validity. PPV and NPV adjusted for food insecurity prevalence in states ranged from 42.8% (Santa Catarina) to 87.6% (Amazonas) and 95.8% (Amazonas) to 99.5% (Santa Catarina), respectively. In conclusion, besides being reproducible, TRIA presented excellent validity parameters, especially among vulnerable groups. It can thus be used in care practice and as an instrument of food and nutritional surveillance in Brazil.

La ausencia de instrumentos de triaje de riesgo para la inseguridad alimentaria compromete la capacidad de evaluar, monitorear y brindar asistencia inmediata a las personas en situación de hambre, especialmente durante emergencias como la crisis de la COVID-19. Por lo tanto, el objetivo de este estudio fue probar la validez del instrumento de Triaje para Riesgo de Inseguridad Alimentaria (TRIA) en diferentes estratos de la población brasileña. El TRIA consta de las preguntas 2 y 4 de la Escala Brasileña de Inseguridad Alimentaria (EBIA), originalmente validada con base en datos de la Encuesta Nacional de Demografía y Salud de la Mujer y el Niño (PNDS 2006). En este estudio, utilizando datos de la Encuesta Nacional por Muestra de Domicilios (PNAD 2013), se probó su reproducibilidad repitiendo los procedimientos combinatorios originales, examinando si los parámetros de sensibilidad, especificidad, exactitud y valores predictivos positivos (VPP) y negativo (VPN) resultarían en el mismo arreglo de preguntas. Además, se analizó la validez convergente comparando la fuerza de asociación entre la inseguridad alimentaria y las variables alimentarias por medio de dos modelos de regresión binomial (TRIA x EBIA). Los resultados indicaron que la combinación de las preguntas 2 y 4 presentó el mejor desempeño entre los estratos poblacionales estudiados, además de excelente validez convergente. El VPP y el VPN ajustado por la prevalencia de inseguridad alimentaria en los estados osciló entre el 42,8% (Santa Catarina) y el 87,6% (Amazonas) y entre el 95,8% (Amazonas) y el 99,5% (Santa Catarina), respectivamente. En conclusión, además de ser reproducible, el TRIA presentó excelentes parámetros de validez, especialmente en grupos en situación de vulnerabilidad. Por lo tanto, se puede recomendar su uso en la práctica asistencial y como instrumento para la vigilancia alimentaria y nutricional en Brasil.

Validity of a 2-item screening tool to identify families at risk for food insecurity in Brazil.

This manuscript aimed to develop a brief 2-item screening tool to identify Brazilian households that include families with children at risk for food insecurity. Psychometric analyses including sensitivity, specificity, positive and negative predictive value, accuracy, and ROC curves were used to test combinations of questions to determine the most effective screener to assess households at risk for food insecurity when compared to a gold standard scale. Participants included Brazilian National Survey of Demography and Health on Women and Children (PNDS) surveyed households with a valid Brazilian Food Insecurity Scale (EBIA) response. The sample included 3,920 households representing 11,779,686 households when expanded using PNDS sample weights. With overall prevalence of food insecurity at 21%, a Brazilian 2-item food-insecurity screen showed sensitivity of 79.31%, specificity of 92.95%, positive predictive value of 74.62%, negative predictive value of 94.5% and ROC area 86.13%. This screen also presented high convergent validity for children's nutrition and health variables when compared with the gold standard, the EBIA full scale. Based on its ability to detect households at risk for food insecurity, a 2-item screening tool is recommended for widespread adoption as a screening measure throughout Brazil, especially when rapid decision-making has been made fundamental, as under the COVID-19 pandemic. This screener can enable providers to accurately identify families at risk for food insecurity and promptly intervene to prevent or ameliorate adverse health and developmental consequences associated with food insecurity and swiftly respond to crises.

Validity of a 2-item screen to identify families at risk for food insecurity in Brazil

This manuscript aimed to develop a brief 2-item screening tool to identify Brazilian households that include families with children at risk for food insecurity. Psychometric analyses including sensitivity, specificity, positive and negative predictive value, accuracy, and ROC curves were used to test combinations of questions to determine the most effective screener to assess households at risk for food insecurity when compared to a gold standard scale. Participants included National Demographic Health Survey on Women and Children (PNDS-2006) surveyed households with a valid Brazilian Household Food Insecurity Measurement Scale (EBIA) response. The sample included 3,920 households representing 11,779,686 households when expanded using PNDS sample weights. With overall prevalence of food insecurity at 21%, a Brazilian 2-item food-insecurity screen showed sensitivity of 79.31%, specificity of 92.95%, positive predictive value of 74.62%, negative predictive value of 94.50% and ROC area 86.13%. This screen also presented high convergent validity for children's nutrition and health variables when compared with the gold standard, the EBIA full scale. Based on its ability to detect households at risk for food insecurity, a 2-item screening tool is recommended for widespread adoption as a screening measure throughout Brazil, especially when rapid decision-making has been made fundamental, as under the COVID-19 pandemic. This screener can enable providers to accurately identify families at risk for food insecurity and promptly intervene to prevent or ameliorate adverse health and developmental consequences associated with food insecurity and swiftly respond to crises.

Validity of a 2-item screening tool to identify families at risk for food insecurity in Brazil / Validade de um instrumento de triagem com dois itens para identificar famílias em risco de insegurança alimentar no Brasil / Validez de un instrumento de 2-ítems para identificar a familias en riesgo de inseguridad alimentaria en Brasil

This manuscript aimed to develop a brief 2-item screening tool to identify Brazilian households that include families with children at risk for food insecurity. Psychometric analyses including sensitivity, specificity, positive and negative predictive value, accuracy, and ROC curves were used to test combinations of questions to determine the most effective screener to assess households at risk for food insecurity when compared to a gold standard scale. Participants included Brazilian National Survey of Demography and Health on Women and Children (PNDS) surveyed households with a valid Brazilian Food Insecurity Scale (EBIA) response. The sample included 3,920 households representing 11,779,686 households when expanded using PNDS sample weights. With overall prevalence of food insecurity at 21%, a Brazilian 2-item food-insecurity screen showed sensitivity of 79.31%, specificity of 92.95%, positive predictive value of 74.62%, negative predictive value of 94.5% and ROC area 86.13%. This screen also presented high convergent validity for children's nutrition and health variables when compared with the gold standard, the EBIA full scale. Based on its ability to detect households at risk for food insecurity, a 2-item screening tool is recommended for widespread adoption as a screening measure throughout Brazil, especially when rapid decision-making has been made fundamental, as under the COVID-19 pandemic. This screener can enable providers to accurately identify families at risk for food insecurity and promptly intervene to prevent or ameliorate adverse health and developmental consequences associated with food insecurity and swiftly respond to crises.

O estudo teve como objetivo desenvolver um instrumento de triagem breve com dois itens para identificar famílias brasileiras com filhos em risco de insegurança alimentar. Foram utilizadas análises psicométricas, inclusive sensibilidade, especificidade, valor preditivo positivo e negativo, acurácia e curvas ROC, para testar as combinações de perguntas e determinar o instrumento mais eficaz para avaliar as famílias com risco de insegurança alimentar, comparado a uma escala padrão-ouro. Os participantes pertenciam aos domicílios da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS), usando a resposta à Escala Brasileira de Insegurança Alimentar (EBIA). A amostra incluiu 3.920 domicílios, representando 11.779.686 domicílios quando expandida com os pesos amostrais da PNDS. Com uma prevalência geral de insegurança alimentar de 21%, o instrumento brasileiro de dois itens para avaliação de insegurança alimentar mostrou sensibilidade 79,31%, especificidade 92,95%, valor preditivo positivo 74,62%, valor preditivo negativo 94,5% e área ROC 86,13%. O instrumento também apresentou validade convergente alta para as variáveis de nutrição e saúde das crianças, comparado ao padrão-ouro, a EBIA completa. Com base na capacidade de detectar domicílios com risco de insegurança alimentar, esse instrumento de triagem com dois itens é recomendado para adoção geral, enquanto medida de triagem em todo o Brasil, sobretudo durante a pandemia da COVID-19, quando as decisões rápidas são fundamentais. O instrumento pode permitir que os profissionais identifiquem com precisão as famílias em risco de insegurança alimentar e intervenham prontamente para prevenir ou mitigar as consequências adversas para a saúde e o desenvolvimento, associadas à insegurança alimentar, respondendo rapidamente às crises.

Este trabajo tuvo el objetivo de desarrollar un instrumento breve de 2 ítems para identificar a los hogares brasileños que incluyen a familias con niños en riesgo de inseguridad alimentaria. Los análisis psicométricos incluyendo sensibilidad, especificidad, valor predictivo positivo y negativo, precisión, y curvas ROC fueron usados para probar combinaciones de preguntas, con el fin de determinar el instrumento más efectivo para evaluar hogares en riesgo de inseguridad alimentaria, cuando se compararon con una escala de estándar de oro. Los participantes incluyeron a los hogares encuestados de la Encuesta Nacional Demográfica sobre la Salud de Mujeres y Niños (PNDS) con una respuesta válida en la Escala de Brasileña de Inseguridad Alimentaria (EBIA). La muestra incluyó 3.920 hogares, representando 11.779.686 hogares, cuando se amplió usando las ponderaciones de la muestra del PNDS. Con la prevalencia general de la inseguridad alimentaria a un 21%, el instrumento de 2 ítems brasileño sobre inseguridad alimentaria mostró una sensibilidad de un 79,31%, especificidad de un 92,95%, un valor predictivo positivo de 74,62%, un valor negativo predictivo de un 94,50% y un área ROC de 86,13%. Este instrumento también presentó una validez convergente alta para la nutrición de los niños y variables de salud, cuando se comparó la escala completa EBIA, el estándar de oro. Basada en su habilidad para detectar hogares en riesgo por inseguridad alimentaria, la herramienta de instrumento de 2 ítems está recomendada para su amplia adopción, como medida de cribado en todo Brasil, especialmente cuando la toma de decisiones rápidas se ha hecho fundamental, como ante la pandemia de COVID-19. Este método de cribado puede permitir a los proveedores de cuidados identificar con precisión a las familias en riesgo de inseguridad alimentaria e intervenir prontamente para prevenir o mejorar salud adversa y las consecuencias en el desarrollo, relacionadas con la inseguridad alimentaria, así como responder con prontitud a las crisis.

Housing Intervention For Medically Complex Families Associated With Improved Family Health: Pilot Randomized Trial.

The effects of housing instability and homelessness on child and adult health are well documented. However, few studies have explored health and housing interventions for families with children with the objective of health improvement. Housing Prescriptions as Health Care is a randomized controlled trial that is investigating the impact on physical and mental health of integrating priority placement in affordable housing and the provision of services (case management, financial, and legal), compared to the standard of care (providing resource guides and hospital-based social work or care navigation services). In 2016-19 seventy-eight homeless or housing-unstable families defined as "medically complex"-with a child or adult member who used more health services than usual or had a chronic disease or disability-were enrolled in the trial, and sixty-seven completed a six-month follow-up. A difference-in-differences analysis at six months showed decreases in the share of children in fair or poor health and in average anxiety and depression scores among parents in the intervention group, relative to the control group. Findings suggest that a population-specific model that integrates health, housing, legal, and social services can improve health-related outcomes at the household level.

Patient experiences and provider perspectives on a hospital-based food pantry: a mixed methods evaluation study.

OBJECTIVE: The purpose of this evaluation study was to identify strengths and opportunities for improvement in programme functioning and common aspects of patients' experiences at a hospital-based food pantry. DESIGN: Semi-structured, in-depth interviews with patients and a cross-sectional survey for providers were used. Interview transcripts were coded using both inductive and deductive approaches and assessed for inter-rater reliability. Descriptive statistics were produced from quantitative data. SETTING: An academic urban safety-net hospital in the Northeastern US offering inpatient and outpatient services. PARTICIPANTS: Thirty patients and 89 providers. RESULTS: Patients expressed feeling comfortable, trusting the food, high satisfaction with food quality, convenience, and lack of stigma at the hospital-based pantry. Patients mentioned the pantry helped them eat more fruits and vegetables, but expressed concerns about the healthfulness of other foods distributed. Providers believed they should discuss food insecurity (FI) with patients (99 %) and that the pantry improves the health of patients (97 %), but faced barriers to consistently screening for FI and referring patients to the pantry, such as insufficient training on FI (53 %) and time constraints (35 %). CONCLUSIONS: Findings suggest hospital-based food pantries may have several advantages. Hospitals with onsite food pantries must work to eliminate barriers to FI screening and pantry referral. To optimize their impact, such pantries should develop nutritional guidelines for food donations and connect patients with nutrition education resources. Future research should examine health outcomes for patients using hospital-based food pantries.

Food Insecurity and the Negative Impact on Brazilian Children's Health-Why Does Food Security Matter for Our Future Prosperity? Brazilian National Survey (PNDS 2006/07).

BACKGROUND: Food insecurity (FI) refers to limited or uncertain access to food resulting from financial constraints. Numerous studies have shown association between FI and adverse health outcomes among adults and children around the world, but in Brazil, such information is scarce, especially if referring to nationally representative information. OBJECTIVE: To test for an independent association between FI and health outcomes. METHODS: Most recent Brazilian Demographic and Health Survey using nationally representative complex probability sampling. Participants were 3923 children <5 years of age, each representing a household. Data from the validated Brazilian Food Insecurity Scale were dichotomized as food secure (food security/mild FI) or food insecure (moderate FI/severe FI). Poisson regression was used to test for associations between FI and various health indicators. RESULTS: Models adjusted for socioeconomic and demographic variables showed that children hospitalized for pneumonia or diarrhea were 30% more prevalent in FI households (adjusted prevalence ratio [aPR]: 1.3; 1.1-1.6). Underweight children were 40% more prevalent in FI households (aPR: 1.4; 1.1-1.7). Children who didn't eat meat and fruits and vegetables every day were 20% and 70% more prevalent in FI households (aPR: 1.2; 1.1-1.4 and aPR: 1.7; 1.3-2.3), respectively. CONCLUSION: Children who grow up in food-insecure households have been shown to have worse health conditions than those in food-secure households. Consequently, their human capital accumulation and work-life productivity are likely to be reduced in the future, leading them into adulthood less capable of generating sufficient income, resulting in a cycle of intergenerational poverty and FI.

Effect of an Educational Program on Schoolchildren's Energy Expenditure during Physical Education Classes / Efeito de um programa de educação no gasto energético de escolares durante as aulas de educação física

OBJECTIVE: Physical activity is a means of prevention of noncommunicable diseases. The level of physical activity of children is decreasing in Brazil, and this can increase the risks of diseases associated with sedentary lifestyles and obesity. METHOD: This is a school-based randomized controlled trial which evaluated the impact of an educational intervention on children's physical activity level, energy expenditure, and teacher's behavior during physical education classes at public schools in São Paulo. The studied population comprised children attending the 1st and the 2nd grades of eight schools (three exposed and five unexposed to teacher training on a course in nutrition and physical activity). Outcomes were measured by direct observation, recorded by a VHS camera during physical education classes; data from 78 physical education classes were analyzed by the System for Observing Fitness Instruction Time - SOFIT. RESULTS: After intervention, results showed highly significant increases in children's physical activity level (walking, p < 0.001; vigorous activities (p < 0.001), and a decrease in the standing category (p < 0.001). It also showed a nonsignificant increase in mean energy expenditure of children (70.6% = 27.6Kcal), but the interaction's effect of group and time (intervention) was highly significant (32.4Kcal; 95%CI 24.7 - 40.1, p < 0.001) indicating the intervention effectiveness in increasing the energy expenditure of children during Physical Education classes. It also showed an increase in length of physical education classes (26.2 to 32.1 minutes (p = 0.01). CONCLUSION: There was a change in teachers' behavior with a positive impact on children's physical activity level and energy expenditure after the educational intervention.

OBJETIVO: A prática de atividade física é uma forma de prevenção de doenças não transmissíveis. O nível de atividade física das crianças tem diminuído no Brasil, fato que pode contribuir para o aumento do risco de doenças associadas com o sedentarismo e a obesidade. MÉTODO: Este é um ensaio educacional randomizado controlado que avaliou o impacto de uma intervenção educacional para professores no nível de atividade física e no gasto energético das crianças, e no comportamento do professor durante as aulas de educação física em escolas públicas de São Paulo. A população estudada compreendeu crianças de 1ᵃ e 2ᵃ series de oito escolas (três expostas e cinco não-expostas ao treinamento de professores em nutrição e atividade física). Os resultados foram medidos por observação direta e gravados por uma câmera VHS durante as aulas de educação física. Dados de 78 aulas de educação física foram analisados segundo o System for Observing Fitness Instruction Time - SOFIT. RESULTADOS: Após intervenção, os resultados mostraram aumentos significantes no nível de atividade física das crianças (caminhada, p < 0.001; atividades vigorosas (p < 0.001), e diminuição na categoria na qual a criança permanecia em pé (p < 0.001)). No entanto, os resultados mostraram um aumento não-significante na média do gasto energético pelas crianças (70.6% = 27.6Kcal), porém a interação do grupo e do tempo (intervenção) foi altamente significante (32.4Kcal; 95% CI 24.7; 40.1, p < 0.0001) indicando a efetividade da intervenção em aumentar o gasto energético das crianças durante a aulade educação física. Os resultados mostraram também um aumento na duração da aula de educação física (26.2 para 32.1 minutos (p = 0.01). CONCLUSÃO: Houve diferença no comportamento dos professores com um impacto positivo no nível de atividade física e no gasto energético das crianças após a intervenção educacional.