Poverty indicators and mental health functioning among adults living with HIV in Delhi, India.

Poor mental health functioning among persons living with HIV (PLHIV) has gained considerable attention particularly in low-income countries that disproportionately carry the global HIV/AIDS burden. Fewer studies, however, have examined the relationship between poverty indicators and mental health among PHLIV in India. Based on this cross-sectional study of 196 HIV-seropositive adults who received medical services at Shalom AIDS Project in Delhi, India, structural equation modeling and mediation analysis were employed to estimate the associations between poverty indices (household asset index, food security, unemployment, water treatment, sanitation), HIV-health factors (illness in the past 3 months, co-morbid medical conditions), and psychological distress. In the final model, ownership of fewer household assets was associated with higher levels of food insecurity, which in turn was associated with higher psychological distress. Also, the household asset index, food insecurity, and unemployment had a larger effect on psychological distress than new opportunistic infections. These findings build on increasing evidence that support concerted efforts to design, evaluate, and refine HIV mental health interventions that are mainstreamed with livelihood programming in high poverty regions in India.

The potential impact of Supplemental Nutrition Assistance Program (SNAP) restrictions on expenditures: a systematic review.

OBJECTIVE: To systematically review the potential impact of reducing the set of Supplemental Nutrition Assistance Program (SNAP)-eligible foods (e.g. not allowing purchase of sugar-sweetened beverages with SNAP benefits) on expenditures for restricted foods. DESIGN: The impact on food expenditures of a $US 1 reduction in available SNAP benefits can be used to estimate the impact of restrictions on SNAP-eligible foods. An electronic search of EconPapers, AgEcon Search, EconLit, WorldCat, ProQuest Dissertations and Theses, PubMed and NALDC, and a snowball search were conducted to obtain a sample of studies up to March 2015 that estimate the impacts of SNAP and other income on household food expenditures. The studies were classified according to study population, study design and whether they attempted to correct for major study design biases. SETTING: Estimates were extracted from fifty-nine published and unpublished studies. SUBJECTS: US households. RESULTS: Fifty-nine studies were found, yielding 123 estimates of the impact of SNAP benefits on food expenditures and 117 estimates of the difference in impacts between SNAP benefits and other income. Studies correcting for or mitigating study design biases had less estimate variation. Estimates indicate that expenditures on the restricted item would decrease by $US 1·6 to $US 4·8 if $US 10 of SNAP benefits would have otherwise been spent, with a median overall impact of $US 3. CONCLUSIONS: The present literature suggests that restrictions on SNAP-eligible items may result in a small but potentially meaningful decrease in SNAP expenditures for restricted items. Further research is needed to evaluate whether this would translate into improvements in diet quality.

Supplemental Nutrition Assistance Program Work Requirements and Emergency Food Assistance Usage.

INTRODUCTION: Policymakers have suggested and implemented work requirements for safety-net programs such as the Supplemental Nutrition Assistance Program (SNAP). If these work requirements impact program participation, they may lead to greater food insecurity. This paper investigates the effects of implementing the work requirement for the SNAP on emergency food assistance usage. METHODS: Data were used from a cohort of food pantries in Alabama, Florida, and Mississippi, which imposed the SNAP work requirement in 2016. Event study models were run in 2022, leveraging geographic variation in exposure to the work requirement to measure changes in the number of households served by the food pantries. RESULTS: The 2016 introduction of the SNAP work requirement increased the number of households served by food pantries. The impact is concentrated among urban food pantries. On average, an urban agency exposed to the work requirement served 34% more households in the 8 months after the work requirement than an agency with no exposure. CONCLUSIONS: Individuals who lose SNAP eligibility owing to the work requirement remain in need of assistance and seek other sources of food. SNAP work requirements thus increase the burden on emergency food assistance programs. Work requirements for other programs may also lead to increased emergency food assistance use.

Preferences Toward COVID-19 Diagnostic Testing Features: Results From a National Cross-Sectional Survey.

PURPOSE: Describe preferences toward COVID-19 testing features (method, location, hypothetical monetary incentive) and simulate the effect of monetary incentives on willingness to test. DESIGN: Online cross-sectional survey administered in July 2020. SUBJECTS: 1,505 nationally representative U.S. respondents. MEASURES: Choice of preferred COVID-19 testing options in discrete choice experiment. Options differed by method (nasal-swab, saliva), location (hospital/clinic, drive-through, at-home), and monetary incentive ($0, $10, $20). ANALYSIS: Latent class conditional logit model to classify preferences, mixed logit model to simulate incentive effectiveness. RESULTS: Preferences were categorized into 4 groups: 34% (n = 517) considered testing comfort (saliva versus nasal swab) most important, 27% (n = 408) were willing to trade comfort for monetary incentives, 19% (n = 287) would only test at convenient locations, 20% (n = 293) avoided testing altogether. Relative to no monetary incentives, incentives of $100 increased the percent of testing avoiders (16%) and convenience seekers (70%) that were willing to test. CONCLUSION: Preferences toward different COVID-19 testing features vary, highlighting the need to match testing features with individuals to monitor the spread of COVID-19.

Cross-sectional association of Toxoplasma gondii exposure with BMI and diet in US adults.

Toxoplasmosis gondii exposure has been linked to increased impulsivity and risky behaviors, which has implications for eating behavior. Impulsivity and risk tolerance is known to be related with worse diets and a higher chance of obesity. There is little known, however, about the independent link between Toxoplasma gondii (T. gondii) exposure and diet-related outcomes. Using linear and quantile regression, we estimated the relationship between T. gondii exposure and BMI, total energy intake (kcal), and diet quality as measured by the Health Eating Index-2015 (HEI) among 9,853 adults from the 2009-2014 National Health and Nutrition Examination Survey. Previous studies have shown different behavioral responses to T. gondii infection among males and females, and socioeconomic factors are also likely to be important as both T. gondii and poor diet are more prevalent among U.S. populations in poverty. We therefore measured the associations between T. gondii and diet-related outcomes separately for men and women and for respondents in poverty. Among females <200% of the federal poverty level Toxoplasmosis gondii exposure was associated with a higher BMI by 2.0 units (95% CI [0.22, 3.83]) at median BMI and a lower HEI by 5.05 units (95% CI [-7.87, -2.24]) at the 25th percentile of HEI. Stronger associations were found at higher levels of BMI and worse diet quality among females. No associations were found among males. Through a detailed investigation of mechanisms, we were able to rule out T. gondii exposure from cat ownership, differing amounts of meat, and drinking water source as potential confounding factors; environmental exposure to T. gondii as well as changes in human behavior due to parasitic infection remain primary mechanisms.