Food Insecurity and the Behavioral and Intellectual Development of Children: A Review of the Evidence

Background: Given that an alarming 1 in 5 children in the USA are at risk of hunger (1 in 3 among black and Latino children), and that 3.9 million households with children are food insecure, it is crucial to understand how household food insecurity (HFI) affects the present and future well-being of our children. Purpose: The objectives of this review article are to: (i) examine the association between HFI and child intellectual, behavioral and psycho-emotional development, controlling for socio-economic indicators; (ii) review the hypothesis that HFI is indeed a mediator of the relationship between poverty and poor child development outcomes; (iii) examine if the potential impact of HFI on caregivers’ mental health well-being mediates the relationship between HFI and child development outcomes. Methods: Pubmed search using the key words “food insecurity children.” For articles to be included they had to: (i) be based on studies measuring HFI using an experience-based scale, (ii) be peer reviewed, and (iii) include child intellectual, behavioral and/or socio-emotional development outcomes. Studies were also selected based on backward and forward Pubmed searches, and from the authors’ files. After reviewing the abstracts based on inclusion criteria a total of 26 studies were selected. Results: HFI represents not only a biological but also a psycho-emotional and developmental challenge to children exposed to it. Children exposed to HFI are more likely to internalize or externalize problems, as compared to children not exposed to HFI. This in turn is likely to translate into poor academic/cognitive performance and intellectual achievement later on in life. A pathway through which HFI may affect child development is possibly mediated by caregivers’ mental health status, especially parental stress and depression. Thus, HFI is likely to foster dysfunctional family environments. Conclusion: Findings indicate that food insecure households may require continued food assistance and psycho-emotional support until they transition to a “stable” food secure situation. This approach will require a much better integration of social policies and access to programs offering food assistance and mental health services to those in need. Findings also fully justify increased access of vulnerable children to programs that promote early in life improved nutrition as well as early psycho-social and cognitive stimulation opportunities

Becoming breastfeeding friendly in Great Britain - Does implementation science work?

The Becoming Breastfeeding Friendly (BBF) in Great Britain study was conducted during 2017–2019 comprising three country studies: BBF England, Wales and Scotland. It was part of an international project being coordinated during the same period by the Yale School of Public Health across five world regions to inform countries and guide policies to improve the environment for the promotion, protection and support of breastfeeding. This paper reports on the application of the BBF process that is based on an implementation science approach, across the countries that constitute Great Britain (England, Wales and Scotland). The process involves assessing 54 benchmarks across eight interlocking gears that drive a country's ‘engine’ towards a sustainable policy approach to supporting, promoting and protecting breastfeeding. It takes a consensus-oriented approach to the evaluation of benchmarks and the development of recommendations. This paper provides a critical overview of how the process was conducted, the findings and recommendations that emerged and how these were managed. We draw on critical theory as a theoretical framework for explaining the different outcomes for each country and some considerations for future action

Implementation of childhood obesity prevention and control policies in the United States and Latin America: Lessons for cross-border research and practice

Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby-Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, and progress of PAPs across RE-AIM framework dimensions. Evidence-based advocacy along with political will and evidence of scalability and impact were key for successful launch and implementation of all PAPs. Diverse adaptations of PAP design and implementation had to be done across contexts. Stronger process and impact monitoring and evaluation systems that track equity indicators are needed to maximize the population benefits of these PAPs. Implementation science offers an important contribution toward addressing knowledge gaps, enhancing obesity policy dialogue, and producing transferable lessons across the Americas and, therefore, should be used for research and evaluation during PAP development and throughout the implementation and maintenance phases

Filling in the Food Security Gaps: Examining The Farmers\u27 Market System in Norwalk, Connecticut

Farmers’ markets are seen as important venues for increasing access to nutritious food and mitigating chronic diseases. The 2016 Community Health Needs Assessment found chronic disease/obesity to be the primary health priority for the Greater Norwalk Region. In Norwalk, the prevalence of adult obesity reported in 2017 (22%) was significantly higher than the surrounding towns (11%). Farmers’ markets (FM) could be a potential approach to mitigating Norwalk’s chronic disease/obesity challenges through increasing access to nutritious food sources. While there are several small farmers’ markets held each summer in Norwalk, not much is known about the benefits and challenges of farmers’ market utilization in Norwalk from the perspectives of key stakeholders. The Norwalk Health Department hopes to increase farmers’ market usage as an approach to filling important food security gaps. The objectives of this study were as follows: Identify barriers and benefits of the Norwalk farmers’ market system from the perspective of consumers, farmers, and market managers in the Norwalk farmers’ market system, and increase community access to local, state, and federal resources.https://elischolar.library.yale.edu/ysph_pbchrr/1021/thumbnail.jp

Costos de la licencia de maternidad para apoyar la lactancia materna en Brasil, Ghana y México

Objective To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women’s weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given country in that year. We weighted the population by the probability of having a baby that year among women in formal employment, according to individual characteristics. We applied nationally representative cross-sectional data from fertility, employment and population surveys to estimate the costs of maternity leave for mothers employed in the formal sector in Brazil, Ghana and Mexico for periods from 12 weeks up to 26 weeks, the WHO target for exclusive breastfeeding. Findings We estimated that 640 742 women in Brazil, 33 869 in Ghana and 288 655 in Mexico would require formal maternity leave annually. The median weekly cost of extending maternity leave for formally working women was purchasing power parity international dollars (PPP$) 195.07 per woman in Brazil, PPP$ 109.68 in Ghana and PPP$ 168.83 in Mexico. Conclusion Our costing method could facilitate evidence-based policy decisions across countries to improve maternity protection benefits and support breastfeeding

The yearly financing need of providing paid maternity leave in the informal sector in Indonesia

Background: The economic cost of not breastfeeding in Indonesia is estimated at US$1.5–9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15–49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the financing need of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia. Method: The costing methodology used is the adapted version of the World Bank methodology by Vilar-Compte et al, following pre-set steps to estimate costs using national secondary data. We used the 2018 Indonesian National Socio-Economic Survey to estimate the number of women working informally who gave birth within the last year. The population covered, potential cash transfer’s unitary cost, the incremental coverage of the policy in terms of time and coverage, and the administrative costs were used to estimate the cost of MCT for the informal sector. Result: At 100$175million (US$152/woman) to US$669million (US$583/woman). The share of the yearly financing need did not exceed 0.5% of Indonesian Gross Domestic Product (GDP). Conclusions: The yearly financing need of providing MCT for eligible WRA working in the informal sector is economically attractive as it amounts to less than 0.5% of GDP nominal of Indonesia. While such a program would be perceived as a marked increase from current public health spending at the onset, such an investment could substantially contribute to the success of breastfeeding and substantial corresponding public health savings given that more than half of working Indonesian WRA are employed in the informal sector. Such policies should be further explored while taking into consideration realistic budget constraints and implementation capacity

Household food insecurity in Brazilian adolescents: a validation study

Os objetivos do trabalho foram avaliar a validade interna e a capacidade preditiva da escala de segurança alimentar de seis itens aplicada a adolescentes. Foi um estudo transversal com amostra representativa de adolescentes brasileiros (N=14.690), realizado em escolas públicas e privadas nas 26 capitais de estados brasileiros e no Distrito Federal por meio de questionário online. A maior parte dos respondentes era do sexo feminino (53,2%), com idade média de 14,4 anos, sendo 72,7% de escolas públicas. O comportamento da escala, observado pelo modelo de Rasch, foi melhor sem o item cinco, apresentando valores ótimos de Infit e nível de severidade crescente entre os itens. O alfa de Cronbach foi 0,77, e as análises do funcionamento diferencial dos itens mostraram comportamento dos itens semelhante entre os subgrupos avaliados. A análise fatorial mostrou a unidimensionalidade do instrumento. Foi proposta a retirada do item cinco e novos pontos de corte para a escala curta de segurança alimentar. A escala curta de segurança alimentar é válida e confiável para mensurar insegurança alimentar domiciliar entre adolescentes brasileiros.284385395The objective of this study was to evaluate the internal and predictive validity of a six-item household food insecurity scale to measure food insecurity in Brazilian adolescents. A cross-sectional study with a representative sample of Brazilian adolescents (N=14,690) was conducted in public and private schools in 26 state capitals and in the Federal District of Brazil using an online questionnaire. Most respondents were female (53.2%) with mean age of 14.4 years, and 72.7% of them attended public schools. The psychometric properties of the scale, assessed using the Rasch model, showed better response rates without the item five, exhibiting optimal Infit statistics and an increasing level of severity among the items. Cronbach's á was 0.767. Differential item functioning analyses showed similar behavior between the items in the subgroups evaluated. Factor analysis confirmed the unidimensionality of the scale. This study proposes the removal of the item five and the inclusion of new cut-off points for this short form of the scale. The Household Food Security Scale (short form) is valid and reliable to measure household food insecurity in Brazilian adolescents

Características psicométricas de la escala de seguridad alimentaria ELCSA aplicada en Colombia, Guatemala y México.

La inseguridad alimentaria es un fenómeno que afecta a millones de hogares en América Latina. Herramientas válidas y confiables para su medición son esenciales para la mejor focalización de los programas abocados a este problema. La Escala Latinoamericana y del Caribe de Seguridad Alimentaria (ELCSA) ha sido propuesta como instrumento regional y fue recientemente aplicada en Colombia, Guatemala y México. Este estudio evalúa las características psicométricas del instrumento y estima el grado de similitude entre esas mediciones. Inicialmente, se determinó que 15 ítems tuvieron contenidos equivalentes en los tres países. Al aplicarle el modelo matemático de Rasch, ELCSA mostró buen ajuste a ese modelo y un comportamiento consistente con el marco conceptual subyacente. Sin embargo, entre Guatemala y México se detectaron diferencias mayores a 1,0 lógitos en cuatro ítems, de los cuales uno solo presentó una diferencia cercana a 2 lógitos. Al omitir este ítem de subsiguientes análisis se atenuaron las diferencias en los otros ítems. Variaciones en el lenguaje, así como en el diseño de las muestras analizadas explicarían en parte los resultados de este estudio. A pesar de las diferencias detectadas, ELCSA parece medir de manera similar la experiencia de los hogares que confrontan situaciones de inseguridad alimentaria

(In) Segurança Alimentar: experiência de grupos focais com populações rurais do Estado de São Paulo

O presente trabalho apresenta a experiência de grupos focais com participantes oriundos de populações rurais do Estado de São Paulo, que possibilitou analisar e elucidar a compreensão existente acerca dos conceitos utilizados pela Escala Norte-Americana para Medida de Segurança Alimentar (USDA Core Food Security Module, hoje denominada Household Food Insecurity Access Scale - HFIAS), previamente adaptada e validada para populações brasileiras urbanas. Essa fase qualitativa antecedeu e forneceu subsídios para realização da fase quantitativa do estudo de validação dessa escala para populações rurais. Foram realizados dois grupos focais, compostos, cada um, por 12 participantes, escolhidos e convidados para representar diferentes categorias da população rural paulista, incluindo: assentados, agricultores familiares tradicionais, trabalhadores assalariados e quilombolas. Os conceitos e palavras-chave investigados foram: “Segurança alimentar”; “Qualidade da alimentação”; “Alimentação saudável”; “Alimentação variada”; “Alimentação saudável e variada”; “Alimento suficiente”; “Condições para ter alimento suficiente: trocas, reserva, estoque, produção de alimentos para consumo e compra de alimentos”; “Dinheiro suficiente”; “Ficar sem nenhum dinheiro”; “Insegurança alimentar” e “Fome”. Os participantes expressaram uma compreensão abrangente sobre segurança alimentar, englobando diferentes aspectos do tema. A análise dos depoimentos desses grupos focais apontou para o reconhecimento no conceito de segurança alimentar do direito humano à alimentação, o que envolve também questões como acesso ao trabalho, saúde, educação, moradia e renda. Na compreensão do termo “Qualidade da alimentação” ficou evidente a preocupação com o consumo de produtos sem agrotóxicos, tendo sido observadas, em menor escala, referências às questões de preço e aparência mais recorrentes nos grupos focais com populações urbanas. Os resultados conduziram a modificações no questionário e contribuíram para o desenvolvimento da Escala Brasileira de Insegurança Alimentar (EBIA), válida para diagnosticar essa condição e monitorar o impacto de políticas voltadas para o combate à fome no país. O processo de validação concluído permitiu o uso da escala brasileira em projetos de pesquisa sobre segurança alimentar que atenderam a um edital do CNPq, ainda em 2003, e posteriormente, essa escala foi incorporada ao suplemento de segurança alimentar da Pesquisa Nacional por Amostra de Domicílios (PNAD-2004), do Instituto Brasileiro de Geografia e Estatística (IBGE)