Nutritional Consequences of Food Insecurity in a Rural New York State County

This study of women with children in a rural county of upstate New York examined the relationships of food insecurity and income with two nutritional consequences (adiposity and fruit and vegetables consumption), and assessed whether disordered eating patterns is a mediator for the effects of food insecurity and income on these nutritional consequences. Each of 193 respondents was interviewed twice in her home. Data were collected on household food stores, socioeconomic and demographic characteristics, methods of obtaining food, food program participation, household expenditures, food intake, the Radimer/Cornell hunger and food insecurity items, height, weight, frequency of fruit and vegetable consumption, and disordered eating patterns. Regression analysis was used to analyze the relationships of body mass index and an obesity classification with height, income, education, single parenthood, employment, food insecurity, disordered eating, and frequency of fruit and vegetable consumption. Regression analysis was also used to examine the relationships of disordered eating and frequency of fruit and vegetable consumption with the other variables. Lower income and unemployment were related to higher adiposity. The effects of income on adiposity were not mediated through disordered eating patterns or through fruit and vegetable consumption. Food insecurity was related to adiposity, and part of this effect of food insecurity was mediated through disordered eating. This mediating effect of disordered eating partially explained why those experiencing the least severe food insecurity were more likely to be overweight than those who were food secure, but those experiencing the most severe food insecurity were less likely to be overweight than those who were food secure. Food insecurity was related to lower fruit and vegetable consumption, but this did not translate into effects on adiposity.

Individual and Structural Environmental Influences on Utilization of IRON and Folic Acid Supplementation Among Pregnant Women in Harare, Zimbabwe

Micronutrient deficiencies are prevalent among Zimbabweans with serious health and social implications. Due to alack of a national micronutrient food fortification policy, the Zimbabwe Ministry of Health and Child Careestablished a policy for the prevention of maternal micronutrient deficiencies, which centres on pregnant womenreceiving daily iron and folic acid (IFA) at theirfirst antenatal care visit and throughout pregnancy. Despite theseefforts, utilization of IFA supplementation in pregnancy in Zimbabwe is low. This study aimed to understand theexperiences and knowledge of IFA supplementation among pregnant women and healthcare workers in Harare,Zimbabwe, and the influence of health-service and social environments on utilization. Semi-structured in-depthinterviews were conducted in Shona and English, with pregnant women (n= 24) and healthcare workers (n=14)providing direct antenatal care services to pregnant women in two high-density community clinics. Data wereanalysed thematically using NVivo 10. Influences on utilization were at the individual and structural environmentallevels. Reasons for low utilization of IFA supplementation included forgetting to take IFA, side effects, misconcep-tions about IFA, limited access to nutrition information, delayed entry or non-uptake of antenatal care and socialnorms of pregnant women for IFA supplementation. Utilization was enhanced by knowledge of risks and benefitsof supplementation, fear of negative health complications with non-utilization, family support and healthcareworker recommendation for supplementation. Studyfindings can inform approaches to strengthen micronutrientsupplementation utilization to improve the micronutrient status of pregnant women to decrease maternal mortalityand improve overall maternal and child health in Zimbabwe

Terminal Logic Behavior and Strategic Defection of Governmental Officials During Presidential Transitions in Guatemala: Implications for the Sustainability of Food and Nutrition Security Policy

Background: Presidents with no possibility of re-election overvalue far-future rewards and succumb to terminal logic behavior (TLB), responding to end-of-tenure legacy concerns despite political context. Government authorities perceiving the outgoing government is losing power at the end of term behave under the logic of strategic defection (SD), dissociating from the outgoing government once it is perceived powerless. In countries where re-election is impossible and government turnover and inconstant political parties are concerns, governmental officials at all levels may show TLB and SD during transitions that affect policy sustainability. Objectives: This study aimed to understand the context during presidential transitions that makes TLB and SD relevant, whether TLB and SD affect sustainability of food and nutrition security policy (FNSP), and the tactics for navigating transitions that favor sustainability. Methods: A case-study design was used with semi-structured qualitative interviews and document review of news articles in Guatemala. Purposeful criteria and snowball sampling were used to recruit 52 policy actors implementing an FNSP across 2 transitions; 252 news articles from the referenced period covering topics on policy programmatic areas were purposefully sampled. Interviews were analyzed using coding and thematic analyses. News articles were analyzed using a priori thematic coding for verifying themes in interviews and data triangulation. Results: Governmental officials were replaced by others during transitions; political parties were perceived as inconstant. TLB and SD occurred at all levels and had consequences for sustainability of FNSP: implementation slow-down, dysfunctional collaboration, inefficient use of resources, benefits not reaching targeted groups, and loss of momentum. These occurred through individual, institutional, and political mechanisms. Civil society, international organizations, and government adopted tactics for maximizing sustainability. Conclusions: Understanding governmental officials\u27 experiences and the extent to which TLB and SD occur and affect sustainability could be advantageous to develop compensatory actions for reaching long-term FNSP goals

Trajectories of Body Mass Index Among Active-Duty U.S. Army Soldiers

Establishing the shape and determinants of trajectories of body mass index (BMI) among Soldiers is critical given the importance of weight management to military service requirements. To establish the shape and determinants of BMI trajectories among Soldiers, we aimed to (1) model the overall BMI trajectory of Soldiers, (2) find the most common trajectory groups among Soldiers, (3) investigate the relationship between BMI trajectories and sociodemographic and military-specific characteristics, and (4) determine if there were Soldiers with large fluctuations in BMI. The study population included all US Army Soldiers on active-duty between 2011 and 2014 who were age 17–62 (n = 827,126). With longitudinal data from the Stanford Military Data Repository, we used group-based trajectory modeling to identify the BMI trajectories of Soldiers and multinomial logistic regression to estimate associations between Soldier characteristics and trajectory membership. Four distinct BMI trajectory groups were found: increasing, decreasing, constant, and inconstant. The constant, increasing, and decreasing trajectories were similar in shape and percentage between men and women. The constant trajectory had the fewest Soldiers who exceeded weight standards or had duty limitations. The increasing trajectory was associated with marriage and fewer service years. The decreasing trajectory was associated with more service years and higher educational attainment. The inconstant trajectory differed in shape between men and women. Over 6% of men and 12% of women had fluctuations in BMI indicative of weight cycling. Understanding the characteristics associated with BMI trends may assist the Army in targeting resources aimed to improve Soldier health and combat readiness

Introduction of Iodised Salt Benefits Infants’ Mental Development in a Community-Based Cluster-Randomised Effectiveness Trial in Ethiopia

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using mixed linear models adjusted for covariates and clusters. The trial was registered at ClinicalTrials.gov, NCT013496. We assessed 1835 infants aged 5–11 months at baseline. The same children (85 % of the sample) were re-assessed at 20–29 months when all villages had iodised salt. At endline, urinary iodine concentration was higher in children in the intervention group compared with those in the control group (median 228·0 v. 155·1 µg/l, P=0·001). The intervention group had higher scores compared with the control group on the Bayley composite score (raw scores:130·60 v. 128·51; standardised scores: 27·8 v. 26·9; d=0·13; 95 % CI 0·02, 0·23) and three of the four subscales: cognitive (53·27 v. 52·54, d=0·13; 95 % CI 0·03, 0·23), receptive language (20·71 v. 20·18, d=0·13; 95 % CI 0·03, 0·24) and fine motor (35·45 v. 34·94, d=0·15; 95 % CI 0·04, 0·25). The introduction of iodised salt contributes to children’s higher urinary iodine concentration and mental development

Parenting Styles Are Associated With Overall Child Dietary Quality Within Low-Income and Food-Insecure Households

Objective: To examine the association between parenting styles and overall child dietary quality within households that are low-income and food-insecure. Design: Child dietary intake was measured via a 24 h dietary recall. Dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). Parenting styles were measured and scored using the Parenting Styles and Dimensions Questionnaire. Linear regressions were used to test main and interaction associations between HEI-2005 scores and parenting styles. Setting: Non-probability sample of low-income and food-insecure households in South Carolina, USA. Participants: Parent–child dyads (n 171). Parents were ≥18 years old and children were 9–15 years old. Results: We found a significant interaction between authoritative and authoritarian parenting style scores. For those with a mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 3·36, P \u3c 0.05). For those with an authoritarian score that was 1 SD above the mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 8.42, P \u3c 0.01). For those with an authoritarian score that was −1 SD below the mean authoritarian score, each unit increase in authoritative score was associated with a lower HEI-2005 score; however, this was not significant (b = −1·69, P \u3e 0·05). Permissive parenting style scores were negatively associated with child dietary quality (b = −2·79, P \u3c 0·05). Conclusions: Parenting styles should be considered an important variable that is associated with overall dietary quality in children living within low-income and food-insecure households

Household Food Insecurity and Children’s Physical Activity and Sedentary Behaviour in the United States: The Healthy Communities Study

OBJECTIVE: To examine associations between household food insecurity and children\u27s physical activity and sedentary behaviours. DESIGN: Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture\u27s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behavior Recall instrument. Data were analyzed using multilevel statistical modelling. SETTING: A total of 130 communities in the USA. PARTICIPANTS: In sum, 5138 US children aged 4-15 years. RESULTS: No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviors was observed (P = 0·03). CONCLUSIONS: Additional research capturing a more detailed assessment of children\u27s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilizing food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex

Elaborating the Science of Food Choice for Rapidly Changing Food Systems in Low-and Middle-Income Countries

The world’s food systems and environments have been changing dramatically, concomitant with changes in overand undernutrition. We elaborate the science of food choice to better understand, analyze, and respond to relationships between changing food environments and food choice. The science of food choice is concerned with generating knowledge about causal drivers of food choice decision making processes and behavior within immediate food and social environments. Three fundamental and interconnected questions undergird this science; 1) what do people eat from the options available and accessible?; 2) how do people interact with food environments?; and 3) why do people decide to acquire, prepare, distribute, and consume foods as they do? Not all food choice behavior is rational, reflexive, or discrete, but is embedded in wider activities of daily lives. The science of food choice involves understanding influences from multiple systems that drive food choice for deriving sound, actionable policy, and programmatic recommendations

Food Insecurity and Violence in a Prospective Cohort of Women at Risk for or Living With HIV in the U.S.

Background Food insecurity and violence are two major public health issues facing U.S. women. The link between food insecurity and violence has received little attention, particularly regarding the temporal ordering of events. The present study used data from the Women’s Interagency Human Immunodeficiency Virus Study to investigate the longitudinal association of food insecurity and violence in a cohort of women at risk for or living with HIV. Methods Study participants completed six assessments from 2013–16 on food insecurity (operationalized as marginal, low, and very low food security) and violence (sexual or physical, and psychological). We used multi-level logistic regression, controlling for visits (level 1) nested within individuals (level 2), to estimate the association of experiencing violence. Results: Among 2,343 women (8,528 visits), we found that victims of sexual or physical violence (odds ratio = 3.10; 95% confidence interval: 1.88, 5.19) and psychological violence (odds ratio = 3.00; 95% confidence interval: 1.67, 5.50) were more likely to report very low food security. The odds of experiencing violence were higher for women with very low food security at both the current and previous visit as compared to only the current visit. HIV status did not modify these associations. Conclusions: Food insecurity was strongly associated with violence, and women exposed to persistent food insecurity were even more likely to experience violence. Food programs and policy must consider persistent exposure to food insecurity, and interpersonal harms faced by food insecure women, such as violence

Association of Multisetting Community Programs and Policies With Child Body Mass Index: The Healthy Communities Study

INTRODUCTION: Expert opinion suggests that efforts to address childhood obesity should seek to transform the environments in which children operate. The objective of this study was to describe the extent to which multisetting programs and policies interact with community and child predictors and are associated with child body mass index (BMI) in the 130 US communities participating in the Healthy Communities Study. METHODS: For 2 years beginning in fall 2013, we collected data through key informant interviews on community programs and policies related to healthy weight among children that occurred in the 10 years before the interview. We characterized community programs and policies by intensity of efforts and the number of settings in which a program or policy was implemented. Child height and weight were measured during household data collection. We used multilevel modeling to examine associations of community programs and policies in multiple settings and child and community predictors with BMI z scores of children. RESULTS: The mean number of settings in which community policies and programs were implemented was 7.3 per community. Of 130 communities, 31 (23.8%) implemented community programs and policies in multiple settings. Higher-intensity community programs and policies were associated with lower BMI in communities that used multiple settings but not in communities that implemented programs and policies in few settings. CONCLUSION: Efforts to prevent childhood obesity may be more effective when community programs and policies are both intensive and are implemented in multiple settings in which children live, learn, and play