Gender, skin color, and household composition explain inequities in household food insecurity in Brazil.

It is well known that female-headed households (FHHs) are more likely to experience food insecurity (FI) than male-headed households (MHHs), however there is a dearth of evidence on how gender intersects with other social determinants of FI. Thus, this paper investigated changes in the prevalence of household FI in Brazil from 2004 to 2018 by the intersection of gender, race/skin color and marital status of the household reference person. Data from three cross-sectional nationally representative surveys that assessed the status of FI using the Brazilian Household Food Insecurity Measurement Scale were analyzed (N2004 = 107,731; N2013 = 115,108, N2018 = 57,204). Multinomial logistic regression models were used to examine the relationship between profiles of gender, race/skin color, marital status of the head of the household with household FI stratified by the presence of children <5 years of age. Over time, FHHs had a higher prevalence of mild and moderate/severe FI than did households headed by men. Food security prevalence increased from 2004 to 2013 and decreased between 2013 and 2018 for households headed by men and women. In 2018, households headed by black/brown single mothers with children < 5 years of age were at the highest FI risk. The probability of reporting moderate/severe FI in these households were 4.17 times higher (95% CI [2.96-5.90]) than for households headed by married white men. The presence of children in the household was associated with a higher probability of moderate/severe FI, especially for households headed by black/brown individuals regardless of the reference person's gender. The results suggest that gender inequities combined with darker skin color and the presence of children at home potentiate the risk of moderate/severe FI. Policy makers need to consider the principles of intersectionality when investing in codesigning, implementing, evaluating, and scaling up evidence-based programs to reduce FI.

[Gender and skin color/race intersections in food insecurity across Brazilian households]. / Interseções de gênero e raça/cor em insegurança alimentar nos domicílios das diferentes regiões do Brasil.

Food insecurity is distributed unequally throughout Brazilian regions. This study aims to investigate the intersections of gender and skin color/race in the cases of food insecurity in households across Brazil. Microdata from the 2018 Brazilian Household Budgets Survey (POF) were used, with a sample of 57,920 households. Food insecurity levels were compared to profiles created from the intersection of gender (man and woman) and skin color/race: white man, white woman, mixed-race man, mixed-race woman, black man, and black woman. Prevalence ratios (PR) were estimated using Poisson regression models to investigate the association of profiles with moderate/severe food insecurity, separated by macroregion. The North had the worst proportions of all food insecurity levels (57%), followed by Northeast (50.4%). The North, Northeast, and Central-West macroregions had prevalence of moderate/severe food insecurity up to five times higher among households headed by women compared to those headed by men (p < 0.001). Moderate/severe food insecurity was associated to households headed by black women in all macroregions of Brazil, but prevalence ratios in Southeast were higher compared to other regions for mixed-race women (PR = 1.16; 95%CI: 1.13-1.20), while the PR was higher in South for black women (PR = 1.17; 95%CI: 1.13-1.21). Outcomes suggest that the intersectional food insecurity data in Brazil - focused on gender, skin color/race and macroregion of residence - should be considered for policies aimed at reducing hunger and related issues.

A insegurança alimentar e seus determinantes se distribuem de forma desigual entre as macrorregiões brasileiras. O objetivo deste estudo foi investigar as intersecções de gênero e raça/cor da pessoa de referência na ocorrência de insegurança alimentar em domicílios nas diferentes regiões do Brasil. Foram utilizados os microdados da Pesquisa de Orçamentos Familiares (POF) de 2018, com amostra de 57.920 domicílios. Os níveis de insegurança alimentar foram considerados com análises em relação aos perfis criados a partir da intersecção do gênero (homem e mulher) e raça/cor: homem branco, mulher branca, homem pardo, mulher parda, homem preto e mulher preta. Razões de prevalência (RP) foram estimadas por meio de modelos de regressão de Poisson para investigar a associação dos perfis com a insegurança alimentar moderada/grave, estratificados por macrorregião. O Norte apresentou as piores proporções de todos os níveis de insegurança alimentar (57%), seguido do Nordeste (50,4%). As regiões Norte, Nordeste e Centro-oeste apresentaram prevalência de insegurança alimentar moderada/grave até 5 vezes maior entre domicílios chefiados por mulheres comparados aos chefiados por homens (p < 0,001). A insegurança alimentar moderada/grave esteve mais associada aos domicílios chefiados pelas mulheres negras em todas as macrorregiões do Brasil, porém, no Sudeste, a RP foi mais elevada, quando comparada às demais regiões, para a mulher parda (RP = 1,16; IC95%: 1,13-1,20), enquanto na Região Sul a RP foi maior para a mulher preta (RP = 1,17; IC95%: 1,13-1,21). Os achados sugerem que o debate interseccional sobre os dados de insegurança alimentar no Brasil, considerando o gênero, a raça/cor da pele e a região de residência, deve ser somado ao tema das políticas voltadas para redução da insegurança alimentar e das iniquidades relacionadas.

La inseguridad alimentaria y sus determinantes está distribuida desigualmente por las macrorregiones de Brasil. El objetivo de este estudio fue investigar las intersecciones de género y raza/color de piel de la persona de referencia en la ocurrencia de inseguridad alimentaria en hogares de diferentes regiones brasileñas. Se utilizaron microdatos de la Encuesta de Presupuestos Familiares (POF) de 2018 de una muestra de 57.920 hogares. Se consideraron los niveles de inseguridad alimentaria con relación a los perfiles creados desde la intersección de género (hombre y mujer) y raza/color de piel: hombre blanco, mujer blanca, hombre pardo, mujer parda, hombre negro y mujer negra. Las razones de prevalencia (RP) se estimaron por modelos de regresión de Poisson para evaluar la asociación de los perfiles con inseguridad alimentaria moderada/grave, estratificados por macrorregión. La Región Norte tuvo las peores proporciones en todos los niveles de inseguridad alimentaria (57%), seguida del Nordeste (50,4%). Las regiones Norte, Nordeste y Centro-oeste mostraron prevalencias moderada/grave de inseguridad alimentaria hasta 5 veces mayores entre los hogares con mujeres como jefas del hogar en comparación con los hogares liderados por hombres (p < 0,001). La inseguridad alimentaria moderada/grave se asoció más en los hogares donde las mujeres negras eran las jefas del hogar en todas las macrorregiones de Brasil, sin embargo, en el Sudeste la RP fue mayor en comparación con las demás regiones para las mujeres pardas (RP = 1,16; IC95%: 1,13-1,20), mientras que en la Región Sur la RP fue mayor para las mujeres negras (RP = 1,17; IC95%: 1,13-1,21). Los hallazgos sugieren que el debate interseccional sobre los datos de inseguridad alimentaria en Brasil, considerando el género, la raza/color de piel y la región de residencia, debe agregarse al tema de las políticas destinadas a reducir la inseguridad alimentaria y sus inequidades asociadas.

Food insecurity in households with persons with disabilities in a situation of extreme vulnerability in Brazil: a secondary cross-sectional analysis.

Background: Inequities in access to education, work and health care are striking among persons with disabilities, making this population more vulnerable to poverty, lack of access to basic services and violation of rights such as access to food. Household food insecurity (HFI), marked by precarious income, has increased among persons with disabilities. In Brazil, the Continuous Cash Benefit (In Portuguese, Benefício de Prestação Continuada - BPC) is the guarantee of a minimum wage for persons with disabilities as a measure to promote social security and access to income in a situation of extreme poverty. Thus, the objective of this study was to assess HFI among persons with disabilities in extreme poverty in Brazil. Methods: A cross-sectional study with national representation was carried out with data from the 2017/2018 Family Budget Survey, with moderate and severe food insecurity as the dependent variable, and the situation of food insecurity measured using the Brazilian Food Insecurity Scale. Prevalence and odds ratio estimates were generated with 99% confidence intervals. Findings: Approximately 25% of households experienced HFI, with a higher prevalence in the North Region (41%), receiving up to 1 income quintile (36.6%), with a female (26.2%) and black person (31%) as a reference. The analysis model found that region, per capita household income, and social benefits received in the household were statistically significant factors. Interpretation: The BPC proved to be an important source of household income for persons with disabilities living in extreme poverty in Brazil: in almost three-quarters of the households, it was the only social benefit received, and, for most of them, it represented more than half of the total household income. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Regional and social inequalities in food insecurity in Brazil, 2013-2018.

This study aims to analyze the association between social indicators and the worsening of food insecurity in 2013 and 2018 in different regions of Brazil. Data from the Brazilian National Household Sample Survey (2013) and Brazilian Household Budgets Survey (2018) were analyzed, considering nationally representative samples of 110,750 and 57,920 households, respectively. Food insecurity was assessed using the Brazilian Food Insecurity Scale by estimating the percentage changes in food insecurity levels between 2013 and 2018, according to sociodemographic variables. The association between social indicators and food insecurity disaggregated by region was estimated using multinomial logistic regression models. Although North and Northeast regions had higher proportions of food insecurity, the Southeast and Central-West regions had the highest increase in food insecurity in the same periods. Income was the indicator with the highest association with food insecurity both in 2013 and 2018. We also observed the association between the presence of three or more residents aged under 18 in a household and a higher risk of food insecurity in North and South regions. Food insecurity increased unevenly among regions during the Brazilian economic crisis, which reinforced regional inequality. Moreover, food insecurity was greater among households with worse social and economic living conditions, contributing to social inequality in the country. Thus, strengthening public policies to promote food security and nutrition according to regional social inequities is necessary.

Changes in the frequency of food consumption by adults/elderly according to food insecurity: evidence from a longitudinal study in the northeastern semi-arid region, Brazil, 2011-2014 / Mudanças na frequência do consumo alimentar de adultos/idosos segundo a situação de insegurança alimentar: evidências a partir de um estudo longitudinal no semiárido nordestino, Brasil, 2011-2014

ABSTRACT Objective: To prospectively analyze changes in the frequency of individual food consumption of adults/elderly people according to different food insecurity outcomes over time. Methods: Population-based longitudinal study carried out in 2011 (358 individuals) and 2014 (301 individuals) in a municipality in the northeastern semi-arid region. The frequency of food consumption of 37 foods in adults/elderly was assessed using the Food Frequency Questionnaire and food insecurity using the Brazilian Food Insecurity Scale. Differences in the proportion of frequency of consumption of each food at baseline (2011) and follow-up (2014) were calculated according to longitudinal categories of change in food insecurity. The McNemar test for paired samples was applied to estimate differences between 2011 and 2014. Results: Among the individuals studied, 38.9% and 30.6% were classified in food security and food insecurity in the two periods (2011 and 2014), respectively, and 23.2% changed from food insecurity in 2011 to food security in 2014. Increase in the frequency of food consumed in the three groups of food insecurity outcomes. Only in the food insecurity group at both times, an increase in the consumption frequency of soft drinks and industrialized juices was observed. In the three groups, when comparing 2011 and 2014, there was an increase in the consumption of local agricultural foods, such as mangoes, sweet potatoes and a decrease in the consumption of pumpkin. Conclusion: Overcoming food insecurity results in positive changes in food consumption, and seasonality is a factor that promotes and limits food consumption.

RESUMO Objetivo: Analisar prospectivamente mudanças na frequência do consumo alimentar individual de adultos/idosos segundo diferentes desfechos de insegurança alimentar no tempo. Métodos: Estudo longitudinal de base populacional realizado em 2011 (358 indivíduos) e 2014 (301 indivíduos) em um município do semiárido nordestino. Foi avaliada a frequência de consumo alimentar de 37 alimentos em adultos/idosos por Questionário de Frequência Alimentar e a insegurança alimentar pela Escala Brasileira de Insegurança Alimentar. Foram calculadas as diferenças na proporção da frequência de consumo de cada alimento no baseline (2011) e follow-up (2014) segundo categorias longitudinais de mudança na insegurança alimentar. Foi aplicado o teste de McNemar para amostras pareadas para estimar diferenças entre 2011 e 2014. Resultados: Dentre os indivíduos estudados, 38,9% e 30,6% foram classificados em segurança e insegurança alimentar nos dois tempos (2011 e 2014), respectivamente, e 23,2% mudaram da insegurança alimentar em 2011 para segurança alimentar em 2014. Houve aumento na frequência dos alimentos consumidos nos três grupos de desfechos da insegurança alimentar. Apenas no grupo insegurança alimentar nos dois tempos, observou-se aumento na frequência alimentar de refrigerantes e sucos industrializados. Nos três grupos, ao comparar 2011 e 2014, houve aumento no consumo de alimentos da vocação agrícola local, como manga, batata-doce e diminuição do consumo de jerimum/abóbora. Conclusão: A superação da insegurança alimentar resulta em mudanças positivas no consumo de alimentos, e a sazonalidade é um fator promotor e limitante do consumo de alimentos.

Inequalities in food acquisition according to the social profiles of the head of households in Brazil / Desigualdades na aquisição de alimentos de acordo com a renda e os perfis sociais do chefe de família no Brasil

Abstract Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family.

Resumo O Brasil é caracterizado por fortes desigualdades sociais e diferenças no acesso a alimentos de qualidade e em quantidade suficiente, o que representa uma violação do direito humano à alimentação adequada. O objetivo foi avaliar os gastos com alimentação de acordo com o perfil social do responsável pelo domicílio. Dados da Pesquisa de Orçamentos Familiares Brasileiros de corte transversal (2017/2018) foram usados com uma amostra nacionalmente representativa de participantes da pesquisa domiciliar (n=52.917). A regressão de Poisson foi utilizada para estimar razões de prevalência (RP) para avaliar a associação de diferentes perfis sociais com a aquisição de alimentos. O perfil caracterizado pela mulher auto classificada como branca, com maior escolaridade, cujas características estiveram positiva e significativamente associadas a maior aquisição de frutas (RP=1,22; IC95% 1,09-1,36), verduras e legumes (PR=1,24; IC95% 1,09-1,41) e queijo (RP=1,32; IC95% 1,09-1,59). Mulheres negras com baixa escolaridade apresentaram associação negativa com o consumo de refrigerantes (RP=0,53; IC95% 0,45-0,62) e alimentos preparados (RP=0,52; IC95% 0,37-0,74). Os resultados revelam grandes desigualdades na aquisição de alimentos entre os perfis sociais dos chefes de família.

Inequalities in food acquisition according to the social profiles of the head of households in Brazil.

Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family.

Access to governmental programs/benefits and food insecurity in urban and rural areas of Northeast Brazil. / Acesso aos benefícios e programas governamentais e insegurança alimentar nas áreas rurais e urbanas do Nordeste brasileiro.

This paper analyzes food insecurity (FI) in urban and rural areas of the Northeast region of Brazil associated with certain social determinants and access to governmental benefits/programs. Data about FI from the National Household Budget Survey (2017-2018) were analyzed, including socio-economic variables and access to government benefits/programs of supplemental income (Bolsa Família, Ongoing transfer benefits, Food voucher and Food basket). Multinomial logistic regression models were performed to assess the relationship between FI and access to government programs/benefits. Half of the families in the Northeast were classified as being subject to FI, the prevalence and severity being higher in rural households. The composition of the family, with at least one retired individual, significantly reduced the probability of being FI at all levels of severity. Access to the Food basket (in cash) benefit and Bolsa Família was associated with being a factor of protection against severe FI in rural areas, while in urban areas the food voucher benefit was the main factor of protection. Income transfer programs and access to social benefits contribute to combatting FI, highlighting the importance of maintaining and scaling-up these initiatives for vulnerable populations.

O trabalho analisa a insegurança alimentar (IA) nas áreas urbana e rural da região Nordeste do Brasil e sua associação com fatores sociais e o acesso a benefícios/programas governamentais. Foram avaliados dados sobre IA da Pesquisa de Orçamentos Familiares (2017-2018), considerando variáveis socioeconômicas e o acesso a benefícios/programas governamentais de transferência de renda (Bolsa Família, Benefício de Prestação Continuada, Cartão Alimentação e Cesta de Alimentos). Modelos de regressão logística multinomial tendo IA como desfecho foram utilizados para avaliar a relação com os programas governamentais. Metade das famílias se encontrava em IA, sendo maior a prevalência e gravidade nos domicílios rurais. A composição da família por ao menos um indivíduo aposentado reduziu significativamente a probabilidade de ocorrência dos níveis mais severos da IA. O acesso à Cesta de Alimentos (em dinheiro) e ao Bolsa Família associou-se como fator de proteção para a IA grave na área rural; na área urbana, o benefício Cartão Alimentação foi o principal fator de proteção. Programas de transferência de renda e o acesso a benefícios sociais contribuíram para o enfrentamento da IA, destacando a relevância da manutenção e ampliação dessas iniciativas para populações vulnerabilizadas.

National Trends and Disparities in Severe Food Insecurity in Brazil between 2004 and 2018.

Background: The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil and facilitates the monitoring and improvement of national public policies to promote food security. Since 2004, the Brazilian government has conducted National Household Sample Surveys, and in 2018, the government carried out the last national evaluation of FI. Objectives: To describe trends in severe FI in Brazil from 2004 to 2018. Methods: Data from 3 cross-sectional Brazilian National Household Sample Surveys (sample sizes: 2004 = 112,530; 2009 = 120,910; 2013 = 116,196) and from the last Household Budget Survey (sample size = 57,920) that assessed the status of FI using the EBIA were analyzed. Changes in severe FI during 2 periods (2004-2013; 2013-2018) were estimated while considering sociodemographic factors. Results: The period between 2004 and 2013 was marked by a significant decrease in severe FI (-53.6%), but this trend reversed in 2013-2018 (+43.8%). The greatest decrease in severe FI occurred in the Northeast (-57.6%) among households where the reference person was a man (-57.6%) and self-identified as white (-58.1%) (2004-2013). In 2013-2018, households with children aged ≤4 y (+6.3%) and members aged ≥65 y (+12.5%) experienced the lowest increases in severe FI. Conclusions: After a significant reduction from 2004 to 2013, severe FI increased sharply from 2013 to 2018, likely due to disruptions in public policies aimed at reducing hunger and unemployment rates.

Sex differences in the relationship between food insecurity and weight status in Brazil.

Obesity and undernutrition are manifestations of malnutrition that affect many people worldwide. A lack of access to food may explain the association of food insecurity (FI) with both undernutrition and obesity, but there are other factors that are specifically related to obesity. Studies have also found that FI is related to both overweight and obesity among women but not among men. The present study aimed to evaluate the association between FI and weight status among adults from a nationally representative sample of Brazil and to consider the impacts of sex. Data from the 2017/2018 Household Budget Survey (n=28,112), a national cross-sectional study, were analyzed using the Brazilian Household FI Scale (EBIA) and body mass index (BMI; measured in kg/m2) by individual self-reported weight and height. Associations were estimated by odds ratios (ORs) with 95% confidence intervals (CIs) considering a multinomial logistic regression model. Women with severe FI were more than twice (OR=2.36) as likely to be underweight and had a higher frequency of obesity (OR=1.39). Among men, severe FI status was a protective factor for overweight (OR=0.58) and obesity (OR=0.61). In conclusion, FI was a risk factor for underweight and obesity among women but not among men.

Changes in meal frequency among adolescents living in a socially vulnerable area of the Rio de Janeiro metropolitan region, Brazil. / Mudanças na frequência do consumo de refeições em adolescentes residentes em área de vulnerabilidade social da região metropolitana do Rio de Janeiro, Brasil.

This study described changes in meal frequency over a 5-year period among adolescents living in the Rio de Janeiro metropolitan region. The data used were from two cross-sectional, population-based studies conducted by home visits. In 2005 the final sample was 1089 households with 511 adolescents (aged 12 to 18 years) and in 2010, 1121 households with 314 adolescents. Meal frequency was obtained through self-administered questionnaire and the adolescents were assessed for appropriate weight by BMI cut-off points, by sex and age group. Increasingly, traditional daily lunch was replaced by snacks (from 3.7% to 13.7%) and traditional dinner was eaten (62.9% to 72.0%). Overweight adolescents ate breakfast less often than those not overweight (in 2005, 68.3% and 79.3%, p=0.02 and, in 2010, 59.5% and 77.4%, p=0.03). Traditional daily lunch was increasingly replaced by snacks and consumption of traditional dinner increased over the 5-year period. Also, eating breakfast every day was associated with BMI classification at both study times: those who were overweight consumed breakfast less frequently.

O objetivo deste estudo foi descrever as mudanças na frequência do consumo de refeições de adolescentes residentes na região metropolitana do Rio de Janeiro, em período de 5 anos. Utilizaram-se dados de dois estudos transversais, de base populacional, que foram realizados por meio de visitas domiciliares. Em 2005, a amostra final foi de 1089 domicílios com 511 adolescentes (de 12 a 18 anos), e em 2010 de 1121 domicílios com 314 adolescentes. A frequência do consumo de refeições foi obtida por meio de questionário autopreenchido e a avaliação da adequação de peso dos adolescentes foi realizada com base nos pontos de corte do IMC por sexo e faixa etária. Houve aumento da substituição diária do almoço tradicional por lanche (3,7% para 13,7%) e no consumo do jantar tradicional (62,9% para 72,0%). Os adolescentes com sobrepeso consumiram o desjejum com menor frequência do que aqueles sem sobrepeso (2005: 68,3% vs 79,3% p=0,02, 2010: 59,5% vs 77,4% p=0,03). Conclui-se que houve aumento da substituição diária do almoço tradicional por lanche e no consumo do jantar tradicional no período de 5 anos. Ademais, a prática do desjejum diário se associou com a classificação de IMC nos dois momentos do estudo, de modo que aqueles com sobrepeso consomem o desjejum com menor frequência.

Mudanças na frequência do consumo de refeições em adolescentes residentes em área de vulnerabilidade social da região metropolitana do Rio de Janeiro, Brasil / Changes in meal frequency among adolescents living in a socially vulnerable area of the Rio de Janeiro metropolitan region, Brazil

Resumo O objetivo deste estudo foi descrever as mudanças na frequência do consumo de refeições de adolescentes residentes na região metropolitana do Rio de Janeiro, em período de 5 anos. Utilizaram-se dados de dois estudos transversais, de base populacional, que foram realizados por meio de visitas domiciliares. Em 2005, a amostra final foi de 1089 domicílios com 511 adolescentes (de 12 a 18 anos), e em 2010 de 1121 domicílios com 314 adolescentes. A frequência do consumo de refeições foi obtida por meio de questionário autopreenchido e a avaliação da adequação de peso dos adolescentes foi realizada com base nos pontos de corte do IMC por sexo e faixa etária. Houve aumento da substituição diária do almoço tradicional por lanche (3,7% para 13,7%) e no consumo do jantar tradicional (62,9% para 72,0%). Os adolescentes com sobrepeso consumiram o desjejum com menor frequência do que aqueles sem sobrepeso (2005: 68,3% vs 79,3% p=0,02, 2010: 59,5% vs 77,4% p=0,03). Conclui-se que houve aumento da substituição diária do almoço tradicional por lanche e no consumo do jantar tradicional no período de 5 anos. Ademais, a prática do desjejum diário se associou com a classificação de IMC nos dois momentos do estudo, de modo que aqueles com sobrepeso consomem o desjejum com menor frequência.

Abstract This study described changes in meal frequency over a 5-year period among adolescents living in the Rio de Janeiro metropolitan region. The data used were from two cross-sectional, population-based studies conducted by home visits. In 2005 the final sample was 1089 households with 511 adolescents (aged 12 to 18 years) and in 2010, 1121 households with 314 adolescents. Meal frequency was obtained through self-administered questionnaire and the adolescents were assessed for appropriate weight by BMI cut-off points, by sex and age group. Increasingly, traditional daily lunch was replaced by snacks (from 3.7% to 13.7%) and traditional dinner was eaten (62.9% to 72.0%). Overweight adolescents ate breakfast less often than those not overweight (in 2005, 68.3% and 79.3%, p=0.02 and, in 2010, 59.5% and 77.4%, p=0.03). Traditional daily lunch was increasingly replaced by snacks and consumption of traditional dinner increased over the 5-year period. Also, eating breakfast every day was associated with BMI classification at both study times: those who were overweight consumed breakfast less frequently.

The Role of Income on the Relationship Between the Brazilian Cash Transfer Program (Programa Bolsa Família) and Intimate Partner Violence: Evidence From a Multigroup Path Analysis.

Several initiatives are being proposed to reduce the incidence of intimate partner violence (IPV) worldwide. Actions aimed at women's economic empowerment through income transfer programs are one of those. Still, the literature on their impact is scarce and controversial. This study attempts to shed some light on this matter assessing whether the Brazilian Conditional Cash Transfer Program (Programa Bolsa Família [PBF]) is a protective factor for psychological and physical IPV against women in families of different levels of income. This is a cross-sectional, household-based study conducted in the city of Duque de Caxias, Rio de Janeiro, Brazil. The sample comprised 807 women reporting some intimate relationship in the 12 months before the interview. Information on IPV and participation on PBF were collected through face-to-face interviews using the Revised Conflict Tactics Scales (CTS2) and a direct question, respectively. A multigroup path analysis was applied to study the relations between PBF and psychological and physical IPV, considering confounding factors, some mediators, and moderation by income. The prevalence of both psychological and physical IPV are high, be it in the poverty and the extreme poverty income strata (psychological IPV: 66.2% and 72.7%, respectively; physical IPV: 26.2% and 40.6%, respectively). Results also showed a positive and direct association between PBF and psychological violence, yet only among families above the poverty line (ß = .287, p = .001). The same could be found regarding physical violence, but the effect of PBF was indirect, mediated by psychological violence (ß = .220, p = .003). Findings suggest that actions aimed at preventing IPV should go hand in hand with the PBF and, perhaps, other income transfer programs. This is even more relevant in relation to the less extreme poverty group where cash transfer may further raise conflicts and violence.

Social inequalities among Brazilian older adults: a secondary cross-sectional analysis of a national survey / Desigualdades sociais entre idosos brasileiros: análise transversal de uma pesquisa nacional

Objective: This study aimed to evaluate sociodemographic and economic differences among Brazilian older adults according the region they live in. Methods: This cross-sectional, descriptive-analytical study included older adults aged ≥ 60 years, based on a secondary analysis of public data from a nationally representative survey called the Family Budget Survey. The data were disaggregated according to the 5 regions of the country and associated with sociodemographic and economic characteristics. Analyses of categorical and numerical variables and their associations were performed using multinomial logistic regression. Results: Among all participants in the Family Budget Survey, 26 199 (15%) were older adults. The southeast and south regions were found to had better living conditions and higher proportions of older adults. Regarding race, the southern region had the highest proportion of self-declared Whites, the southeastern region had the highest mean education level, and the northern and northeastern regions had the lowest levels of education and household income. Conclusions: The results suggest that the aging process is heterogeneous due to marked regional inequalities, which are related to social issues. Regional differences can be determinant in socioeconomic and demographic inequalities among the older population.

Objetivo: Este estudo teve como objetivo avaliar as diferenças sociodemográficas e econômicas entre idosos brasileiros de acordo com as macrorregiões. Metodologia: Estudo transversal, descritivo-analítico, realizado com indivíduos com ≥ 60 anos de idade, com base na análise secundária de dados públicos de um inquérito nacionalmente representativo denominado Pesquisa de Orçamentos Familiares. Os dados foram separados de acordo com as cinco regiões do País e foram associados a características sociodemográficas e econômicas. Realizaram-se análises de variáveis categóricas e numéricas e de suas associações por meio de regressão logística multinomial. Resultados: Entre todos os participantes da Pesquisa de Orçamentos Familiares, 26.199 (15%) eram idosos. Constatou-se que as regiões Sudeste e Sul apresentaram melhores condições de vida e maiores proporções de idosos. Em relação à raça/cor, a região Sul apresentou a maior proporção de autodeclarados brancos, a região Sudeste apresentou a maior média de escolaridade e as regiões Norte e Nordeste apresentaram os menores níveis de escolaridade e renda familiar. Conclusões: Os resultados sugerem que o processo de envelhecimento é heterogêneo em razão das acentuadas desigualdades regionais, que estão relacionadas a questões sociais. As diferenças regionais podem ser determinantes nas desigualdades socioeconômicas e demográficas entre a população idosa.

Interseções de gênero e raça/cor em insegurança alimentar nos domicílios das diferentes regiões do Brasil / Gender and skin color/race intersections in food insecurity across Brazilian households / Intersecciones de género y raza/color en la inseguridad alimentaria en hogares de diferentes regiones de Brasil

A insegurança alimentar e seus determinantes se distribuem de forma desigual entre as macrorregiões brasileiras. O objetivo deste estudo foi investigar as intersecções de gênero e raça/cor da pessoa de referência na ocorrência de insegurança alimentar em domicílios nas diferentes regiões do Brasil. Foram utilizados os microdados da Pesquisa de Orçamentos Familiares (POF) de 2018, com amostra de 57.920 domicílios. Os níveis de insegurança alimentar foram considerados com análises em relação aos perfis criados a partir da intersecção do gênero (homem e mulher) e raça/cor: homem branco, mulher branca, homem pardo, mulher parda, homem preto e mulher preta. Razões de prevalência (RP) foram estimadas por meio de modelos de regressão de Poisson para investigar a associação dos perfis com a insegurança alimentar moderada/grave, estratificados por macrorregião. O Norte apresentou as piores proporções de todos os níveis de insegurança alimentar (57%), seguido do Nordeste (50,4%). As regiões Norte, Nordeste e Centro-oeste apresentaram prevalência de insegurança alimentar moderada/grave até 5 vezes maior entre domicílios chefiados por mulheres comparados aos chefiados por homens (p < 0,001). A insegurança alimentar moderada/grave esteve mais associada aos domicílios chefiados pelas mulheres negras em todas as macrorregiões do Brasil, porém, no Sudeste, a RP foi mais elevada, quando comparada às demais regiões, para a mulher parda (RP = 1,16; IC95%: 1,13-1,20), enquanto na Região Sul a RP foi maior para a mulher preta (RP = 1,17; IC95%: 1,13-1,21). Os achados sugerem que o debate interseccional sobre os dados de insegurança alimentar no Brasil, considerando o gênero, a raça/cor da pele e a região de residência, deve ser somado ao tema das políticas voltadas para redução da insegurança alimentar e das iniquidades relacionadas.

Food insecurity is distributed unequally throughout Brazilian regions. This study aims to investigate the intersections of gender and skin color/race in the cases of food insecurity in households across Brazil. Microdata from the 2018 Brazilian Household Budgets Survey (POF) were used, with a sample of 57,920 households. Food insecurity levels were compared to profiles created from the intersection of gender (man and woman) and skin color/race: white man, white woman, mixed-race man, mixed-race woman, black man, and black woman. Prevalence ratios (PR) were estimated using Poisson regression models to investigate the association of profiles with moderate/severe food insecurity, separated by macroregion. The North had the worst proportions of all food insecurity levels (57%), followed by Northeast (50.4%). The North, Northeast, and Central-West macroregions had prevalence of moderate/severe food insecurity up to five times higher among households headed by women compared to those headed by men (p < 0.001). Moderate/severe food insecurity was associated to households headed by black women in all macroregions of Brazil, but prevalence ratios in Southeast were higher compared to other regions for mixed-race women (PR = 1.16; 95%CI: 1.13-1.20), while the PR was higher in South for black women (PR = 1.17; 95%CI: 1.13-1.21). Outcomes suggest that the intersectional food insecurity data in Brazil - focused on gender, skin color/race and macroregion of residence - should be considered for policies aimed at reducing hunger and related issues.

La inseguridad alimentaria y sus determinantes está distribuida desigualmente por las macrorregiones de Brasil. El objetivo de este estudio fue investigar las intersecciones de género y raza/color de piel de la persona de referencia en la ocurrencia de inseguridad alimentaria en hogares de diferentes regiones brasileñas. Se utilizaron microdatos de la Encuesta de Presupuestos Familiares (POF) de 2018 de una muestra de 57.920 hogares. Se consideraron los niveles de inseguridad alimentaria con relación a los perfiles creados desde la intersección de género (hombre y mujer) y raza/color de piel: hombre blanco, mujer blanca, hombre pardo, mujer parda, hombre negro y mujer negra. Las razones de prevalencia (RP) se estimaron por modelos de regresión de Poisson para evaluar la asociación de los perfiles con inseguridad alimentaria moderada/grave, estratificados por macrorregión. La Región Norte tuvo las peores proporciones en todos los niveles de inseguridad alimentaria (57%), seguida del Nordeste (50,4%). Las regiones Norte, Nordeste y Centro-oeste mostraron prevalencias moderada/grave de inseguridad alimentaria hasta 5 veces mayores entre los hogares con mujeres como jefas del hogar en comparación con los hogares liderados por hombres (p < 0,001). La inseguridad alimentaria moderada/grave se asoció más en los hogares donde las mujeres negras eran las jefas del hogar en todas las macrorregiones de Brasil, sin embargo, en el Sudeste la RP fue mayor en comparación con las demás regiones para las mujeres pardas (RP = 1,16; IC95%: 1,13-1,20), mientras que en la Región Sur la RP fue mayor para las mujeres negras (RP = 1,17; IC95%: 1,13-1,21). Los hallazgos sugieren que el debate interseccional sobre los datos de inseguridad alimentaria en Brasil, considerando el género, la raza/color de piel y la región de residencia, debe agregarse al tema de las políticas destinadas a reducir la inseguridad alimentaria y sus inequidades asociadas.

Acesso aos benefícios e programas governamentais e insegurança alimentar nas áreas rurais e urbanas do Nordeste brasileiro / Access to governmental programs/benefits and food insecurity in urban and rural areas of Northeast Brazil

Resumo O trabalho analisa a insegurança alimentar (IA) nas áreas urbana e rural da região Nordeste do Brasil e sua associação com fatores sociais e o acesso a benefícios/programas governamentais. Foram avaliados dados sobre IA da Pesquisa de Orçamentos Familiares (2017-2018), considerando variáveis socioeconômicas e o acesso a benefícios/programas governamentais de transferência de renda (Bolsa Família, Benefício de Prestação Continuada, Cartão Alimentação e Cesta de Alimentos). Modelos de regressão logística multinomial tendo IA como desfecho foram utilizados para avaliar a relação com os programas governamentais. Metade das famílias se encontrava em IA, sendo maior a prevalência e gravidade nos domicílios rurais. A composição da família por ao menos um indivíduo aposentado reduziu significativamente a probabilidade de ocorrência dos níveis mais severos da IA. O acesso à Cesta de Alimentos (em dinheiro) e ao Bolsa Família associou-se como fator de proteção para a IA grave na área rural; na área urbana, o benefício Cartão Alimentação foi o principal fator de proteção. Programas de transferência de renda e o acesso a benefícios sociais contribuíram para o enfrentamento da IA, destacando a relevância da manutenção e ampliação dessas iniciativas para populações vulnerabilizadas.

Abstract This paper analyzes food insecurity (FI) in urban and rural areas of the Northeast region of Brazil associated with certain social determinants and access to governmental benefits/programs. Data about FI from the National Household Budget Survey (2017-2018) were analyzed, including socio-economic variables and access to government benefits/programs of supplemental income (Bolsa Família, Ongoing transfer benefits, Food voucher and Food basket). Multinomial logistic regression models were performed to assess the relationship between FI and access to government programs/benefits. Half of the families in the Northeast were classified as being subject to FI, the prevalence and severity being higher in rural households. The composition of the family, with at least one retired individual, significantly reduced the probability of being FI at all levels of severity. Access to the Food basket (in cash) benefit and Bolsa Família was associated with being a factor of protection against severe FI in rural areas, while in urban areas the food voucher benefit was the main factor of protection. Income transfer programs and access to social benefits contribute to combatting FI, highlighting the importance of maintaining and scaling-up these initiatives for vulnerable populations.

Changes in prevalence of overweight in adolescents living in areas highly vulnerable to food insecurity. / Mudanças na prevalência de excesso de peso em adolescentes residentes em área de alta vulnerabilidade a insegurança alimentar.

This study ascertained changes, over 5 years, in the prevalence of overweight in adolescents and associations with socio-demographic variables and food insecurity. Two cross-sectional population-based studies were conducted with 511 (2005) and 314 (2010) adolescents resident in Campos Elíseos (Duque de Caxias-RJ). Overweight was evaluated by sex and age specific cut-off points of BMI (weight/height²). The prevalence of food insecurity was investigated using the Brazilian Food Insecurity Scale. Logistic regression was used to determine the association between changes in overweight over time and sex, age, skin colour, and food insecurity. Overweight was found to increase significantly, between 2005 and 2010, in boys who were younger (from 20.1% to 49.5%), black or brown (22.2% to 37.3%), those with per capita income of up to half a minimum wage (13.6% to 32.5%) and those experiencing moderate or severe food insecurity (9.2% to 36.3%). It was concluded that overweight increased significantly in adolescents living in an area of food insecurity, and that younger, black or brown, lower-income adolescents, and those living with moderate and severe food insecurity, were more exposed to that increase.

O objetivo deste estudo foi verificar as mudanças na prevalência do excesso de peso em adolescentes e sua associação com variáveis sociodemográficas e insegurança alimentar em período de 5 anos. Foram realizados dois estudos transversais com 511 (2005) e 314 (2010) adolescentes de 12 a 18,9 anos residentes de Campos Elíseos (Duque de Caxias-RJ). Excesso de peso foi avaliado por meio do IMC (peso/estatura²). A insegurança alimentar foi investigada por meio da Escala Brasileira de Insegurança Alimentar (EBIA). Utilizou-se regressão logística para verificar a associação entre as mudanças temporais de excesso de peso segundo sexo, idade, cor da pele, e insegurança alimentar. Quanto à evolução do excesso de peso pode se notar que nos meninos houve aumento significativo para os mais novos (20,1% para 49,5%), os de cor preta ou parda (22,2% para 37,3%), os que tinham renda per capita de até ½ salário mínimo (13,6% para 32,5%) e os que apresentavam insegurança alimentar moderada e grave (9,2% para 36,3%) entre 2005 e 2010. Conclui-se que o aumento do excesso de peso foi expressivo nos adolescentes residentes em área de insegurança alimentar, e os meninos mais novos, pretos ou pardos, de menor renda e residentes em lares com insegurança alimentar moderada e grave estão mais expostos a este aumento.

Mudanças na prevalência de excesso de peso em adolescentes residentes em área de alta vulnerabilidade a insegurança alimentar / Changes in prevalence of overweight in adolescents living in areas highly vulnerable to food insecurity

Resumo O objetivo deste estudo foi verificar as mudanças na prevalência do excesso de peso em adolescentes e sua associação com variáveis sociodemográficas e insegurança alimentar em período de 5 anos. Foram realizados dois estudos transversais com 511 (2005) e 314 (2010) adolescentes de 12 a 18,9 anos residentes de Campos Elíseos (Duque de Caxias-RJ). Excesso de peso foi avaliado por meio do IMC (peso/estatura²). A insegurança alimentar foi investigada por meio da Escala Brasileira de Insegurança Alimentar (EBIA). Utilizou-se regressão logística para verificar a associação entre as mudanças temporais de excesso de peso segundo sexo, idade, cor da pele, e insegurança alimentar. Quanto à evolução do excesso de peso pode se notar que nos meninos houve aumento significativo para os mais novos (20,1% para 49,5%), os de cor preta ou parda (22,2% para 37,3%), os que tinham renda per capita de até ½ salário mínimo (13,6% para 32,5%) e os que apresentavam insegurança alimentar moderada e grave (9,2% para 36,3%) entre 2005 e 2010. Conclui-se que o aumento do excesso de peso foi expressivo nos adolescentes residentes em área de insegurança alimentar, e os meninos mais novos, pretos ou pardos, de menor renda e residentes em lares com insegurança alimentar moderada e grave estão mais expostos a este aumento.

Abstract This study ascertained changes, over 5 years, in the prevalence of overweight in adolescents and associations with socio-demographic variables and food insecurity. Two cross-sectional population-based studies were conducted with 511 (2005) and 314 (2010) adolescents resident in Campos Elíseos (Duque de Caxias-RJ). Overweight was evaluated by sex and age specific cut-off points of BMI (weight/height²). The prevalence of food insecurity was investigated using the Brazilian Food Insecurity Scale. Logistic regression was used to determine the association between changes in overweight over time and sex, age, skin colour, and food insecurity. Overweight was found to increase significantly, between 2005 and 2010, in boys who were younger (from 20.1% to 49.5%), black or brown (22.2% to 37.3%), those with per capita income of up to half a minimum wage (13.6% to 32.5%) and those experiencing moderate or severe food insecurity (9.2% to 36.3%). It was concluded that overweight increased significantly in adolescents living in an area of food insecurity, and that younger, black or brown, lower-income adolescents, and those living with moderate and severe food insecurity, were more exposed to that increase.