A Cross-Sectional Exploration of Food Security, Depression, and CHAOS in Low-Income Households with Children

Depression has been linked to food security, particularly among low-income mothers. However, less is known about the relationship between CHAOS (Confusion, Hubbub, and Order Scale), a measure of family functioning such as timeliness and order, and varying levels food security. The purpose of this paper was to evaluate the relationship between depression, CHAOS, and sociodemographics on the level of food insecurity in a cross-sectional sample of low-income households with children, ages 0-18 years. Participants were recruited from low-income communities in a medium sized Midwestern city in the United States. Eligible participants were ≥19 years of age, a parent or primary caregiver to at least one child, and English- or Spanish- speaking. Survey items included participation in the Supplemental Nutrition Assistance Program (SNAP), food security, depression, CHAOS, and sociodemographics/family characteristics. Descriptives and Chi-square tests were conducted for all variables. Potential covariates were assessed (e.g., age, income, education, race/ethnicity, sex, SNAP participation, number of children and adults in the household, and marital status) and included in the final logistic regression model through backward elimination. All statistics were conducted using SAS (version 9.4, SAS Institute Inc., Cary, NC). Participants (N=252) were 75% female, 42% Non-Hispanic Black, 31% Non-Hispanic White, 12% Hispanic, and 15% other race categories. The mean number of children in households was 2.33 (SD=1.58), and half of the respondents reported earning ≤$10,000/year. Chi-Square tests showed univariate relationships between study variables and varying household food security levels. Those in the “high” and “medium” groups for depression and CHAOS were both more likely than the “low” groups to experience low or very low food security. Income and education were also related to food security, with low levels of education and low income being associated with low or very low food security. Age, sex, race/ethnicity, and marital status were not associated with food security status. The fully adjusted logistic regression models of depression and CHAOS accounted for 10% and 14% of the variance in food security, respectively (depression: (OR=0.31, CI=0.15-0.65; pp In the current study, CHAOS demonstrated a stronger relationship with food security than depression, when controlling for sociodemographics. CHAOS is a measurement that has not been tested widely among food insecure populations, but has been shown to be an influencing factor on child development, and might help explain some of the stress experienced by low-income families. Understanding more about the psychological aspects of food insecurity may help inform the development of tailored interventions to alleviate food insecurity in low-income households, and ultimately improve health, achievement and related outcomes in children

Monthly SNAP benefit duration and its association with food security, hunger-coping, and physiological hunger symptoms among low-income families

Purpose The purpose of this study was to examine relationships between monthly Supplemental Nutrition Assistance Program (SNAP) benefit duration (i.e., the number of weeks each month a participants’ SNAP benefits provide food), and five primary outcome variables: food security, three hunger-coping behavior scales (rationing food supplies, financial strategies, making trade-offs), and physiological hunger symptoms, among a sample of families with children 0-18 years currently receiving SNAP benefits. Methods Baseline survey data were collected as part of a community-based intervention to alleviate child hunger. Participants included in the analytic sample were current SNAP recipients, parents (or caregivers), and 19 years of age and older (n=161). The survey assessed sociodemographics, household characteristics, food and financial assistance use, food security, three hunger-coping behavior scales, diet intake frequency, and one physiological hunger symptoms scale. The three hunger-coping scales and the physiological hunger scale were dichotomized into a “high” group (if above the sample median score) and a “low” group (if at or below the sample median score). Sociodemographic and family characteristics were included as covariates. Logistic regression models were used to assess relationships between monthly SNAP benefit duration and the five primary outcome variables in this study. Results Respondents were predominately mothers/female caregivers (78%), a majority reported annual family incomes below $10,000 (58%), and 80% were experiencing “low” or “very low” food security. The sample was 43% non-Hispanic black, 30% non-Hispanic white, 10% Hispanic/Latino, 17% American Indian or other racial/ethnic groups. Monthly SNAP benefit duration (M=2.8, SD=1.0) was not likely driven by allotment amount, because households’ percent of the federal poverty line (a proxy measure for allotment amount) was not associated with the number of weeks each month that benefits lasted (p=0.36). After controlling for relevant sociodemographic variables and household characteristics, the more weeks each month participants reported their SNAP benefits lasting, the lower their odds of experiencing “low” or “very low” food security (OR=0.444, 95%CI=0.259-0.761; p Conclusions These findings suggest that monthly SNAP benefit duration may be useful as a proxy for SNAP allotment adequacy in the context of food security and hunger. Families that were not able to make monthly benefits extend as long as other families were more likely to be food insecure and experience “high” levels of physiological hunger symptoms. While associations with hunger-coping behaviors were only significant in univariate analysis, they were in the direction expected and should be further examined in future studies as these behaviors may be exacerbate, buffer, or be symptoms of the experience of food insecurity and hunger among low-income families. Policies are needed to better tailor SNAP benefit allotments to the needs of disadvantaged families, and research and programming is needed to investigate ways these families can better utilize their current allotments as a potential path to address food insecurity and hunger

Food Security, Hunger-coping, and Hunger-Symptoms, and Their Relationship With Daily Fruit and Vegetable Intake Frequency in a Low-income Sample

Purpose To examine daily fruit and vegetable (FV) intake frequency by household food security status (high food security, marginal food security, low food security, and very low food security), and scores on three hunger-coping behavior scales (i.e., “rationing food supplies”, “financial strategies”, and “trade-off strategies”), and one physiological hunger symptoms scale among a very low-income population in the Midwestern United States. Methods Adult participants (aged 19 and older and caregivers to at least one child aged 0-18) were recruited from public libraries, food pantries, and other community locations to participate in a cross-sectional self-administered survey (n = 306). The primary outcome variable was daily FV intake frequency, measured from five items from the 16-item NYPANS dietary screener (fruit, green salad, carrots, other vegetables, and non-fried potatoes). These items were converted into daily frequencies and then summed. Daily FV intake frequency was also log transformed to meet statistical model assumptions. The main independent variables in this study were household food security (measured using the 6-item USDA Household Food Security Survey Module), scores on three 5-item hunger-coping behavior scales (max scores = 5), and one 5-item physiological hunger symptoms scale (max scores = 5). Potential sociodemographic and household characteristics (e.g., sex, age, race/ethnicity, education, income, marital status, food assistance, income assistance, food pantry use, household child to adult ratio, and automobile access) were assessed as potential covariates. Generalized linear models were used to assess the relationship between independent variables and daily FV intake frequency. Results 278 participants provided complete data for the outcome variable and were included in the sample. The sample was 73% female, 45% African American, 14% Hispanic, and 28% Caucasian. A majority of participants (60%) reported annual household incomes under $15,000. A high proportion of participants (42%) had very lowfood security, as compared to the national average of 6%. Participants reported consuming FV 2.40 times per day (SD=1.76) on average. Compared the high food secure group (In adjusted models), being in the “very low” food security group was associated with a 26% decrease, on average, in daily FV intake frequency (exp(β)=0.74, 95%CI=0.61-0.88, p Conclusions Compared to the high food secure group, those in the “very low” food secure group reported a significantly lower mean daily FV intake frequency, but not those in the “low” food secure group. This emphasizes the need to examine the “low” and “very low” food secure groups separately when studying factors associated with diet. Engaging in hunger-coping behaviors and experiencing physiological hunger symptoms was associated with decreased daily FV intake frequency. It is not clear if the hunger coping-behaviors themselves directly lead to decreased daily FV intake frequency, or if they were a marker for food insecurity and associated economic distress. These constructs and relationships should be examined in future studies. Programs and policies, which seek to promote fruit and vegetable intake among low-income populations, should target the “very low” food secure as the most at-risk for low intake. Also, researchers and community organizations working with food insecure groups could potentially measure hunger-coping behaviors and hunger symptoms in a complementary fashion to traditional measures of food insecurity to gain more contextual information about the experiences of this population

What’s Next for Tobacco Control Efforts? Health Equity Related Lessons Learned from a National Qualitative Study on Tobacco Control and Prevention

Context: Despite gains in the tobacco prevention and control movement, tobacco products remain a threat, with specific populations at greater risk. Objective: The purpose of this paper is to examine the role that leaders in the tobacco prevention and control movement have played in progress achieved to date and identify recommendations for the future using a health equity framework. The purpose of this paper is to examine the role that leading organizations in the tobacco prevention and control movement have played in progress achieved to date, identify future recommendations within the context of current public health priorities (e.g., obesity prevention), and explore potential for tobacco prevention and control using a health equity framework. Design: Qualitative key informant interviews were conducted with representatives from four key tobacco prevention and control organizations and their partners. Setting: Interviews were conducted on-site at tobacco prevention and control organization offices or by telephone. Participants: Key informant interviews (n=87) were conducted during July-December of 2017. Main outcome measures: Interviewees describe their work in providing technical assistance to leading public health and policy efforts in tobacco prevention and control. Interviews were transcribed verbatim and coded for meaning units. This analysis was conducted November 2017-January 2018. This study was determined exempt from review by the University of Nebraska Medical Center Institutional Review Board. Results: Three overarching themes emerged from our analysis: (1) maintaining tobacco prevention and control as a public health issue, (2) the importance of health equity in tobacco prevention and control work, and (3) planning for the next generation of tobacco prevention and control advocates. Certain populations remain untouched by broad public health approaches to reduce tobacco use. Conclusions: Tailored, focused, and comprehensive approaches to address health equity in tobacco prevention and control work across specific communities are needed. Adopting a health equity lens across public health priority areas (e.g., obesity, opioids, and tobacco prevention and control) could reduce prevalence among vulnerable groups for multiple conditions

Factors Associated with Participation in the Oregon Summer Food Program: A Mixed Methods Analysis

The Summer Food Service Program (SFSP) was established to ensure children eligible for the National School Lunch Program (NSLP) continue to receive meals outside of the school year. However, participation in SFSP is relatively low (2.8 million annually) when compared with NSLP participation (30.4 million annually), suggesting that challenges exist in reaching children. Using a mixed methods approach, this study explored factors associated with SFSP participation. A secondary data analysis of the Oregon SFSP identified factors associated with SFSP participation at the Oregon SFSP-, sponsor-, and site-levels. Semi-structured interviews with SFSP sponsors explored barriers and facilitators to SFSP participation. Results showed increases in the total number of meals served as well as number of sponsors and sites for the Oregon SFSP over the study period. Sponsor average daily participation (ADP) demonstrated a significant decrease over the study period. Sponsors that offered more meal types, greater number of activities, and were school districts had a higher ADP. Results from interviews showed themes of organizational characteristics, site environment, and meal logistics. Findings suggest that strengthening existing sites and tailoring the current SFSP model to allow successful expansion of the program to new sites may have the greatest impact on increasing average daily participation and improve the operational sustainability of the SFSP

Auxiliary measures to assess factors related to food insecurity: Preliminary testing and baseline characteristics of newly designed hunger-coping scales

The objective of this paper is to describe the development and preliminary testing of new scales to assess hunger-coping behaviors in a very low-income population. Very low-income adults (≥19 years), caregivers to at least one child (n = 306) completed a survey in a community setting (e.g., libraries). The survey included novel items assessing hunger-coping behaviors (e.g., trade-offs to purchase food, strategies to stretch and obtain food), food insecurity status, and physiological hunger. Internal consistency of hunger-coping scales, one-way ANOVAs, post-hoc analyses, Spearman's correlations among variables. Respondents were 75% female, 51% African American, 34% White, and 15% Hispanic, and 73% earned <$20,000/year. Four scales emerged: hunger-coping trade-offs, financial coping strategies, rationing coping strategies, and physiological adult hunger symptoms. All scales demonstrated acceptable internal consistency (α/KR-20 = 0.70–0.90). Predictive, construct, and content validity were demonstrated by correlations between hunger-coping scales and food insecurity (FI), measured with the USDA 6-item HFSSM (rs = 0.42–0.68, ps < 0.001). Higher levels of hunger-coping trade-offs (F(2,297) = 42.54, p < 0.001), financial coping strategies (F(2,287) = 70.77, p < 0.001), and rationing coping strategies (F(2,284) = 69.19, p < 0.001), corresponded with increasing levels of FI. These preliminary results support use of newly developed hunger-coping scales in a very low-income population and can compliment traditional food security measures to inform hunger prevention policy and programming. Keywords: Psychometrics, Survey, Food insecurity, Hunger-copin