Christine M. Olson

Understanding hunger and developing indicators to assess it in women and children

Abstract The lack of an operational definition for hunger has been frequently cited as a barrier to progress in addressing the problem. The purposes of this research were to develop an understanding of hunger from the perspective of women who had experienced it and to construct and evaluate indicators to measure hunger directly in similar populations. In-depth interviews were conducted with 32 women of childbearing age from rural and urban areas of Upstate New York. Qualitative analysis of the responses yielded a conceptualization of hunger that included two levels: the individual and household. Hunger at each of these levels had quantitative, qualitative, psychological and social components. These women also viewed hunger as a managed process. Based on this conceptualization of hunger, survey items were developed and evaluated, using data from a questionnaire administered to 189 women from the same geographical area. Three scales, one each for household, womens, and childrens hunger, emerged and were found to be valid and reliable indicators for measuring hunger directly in this population.

Nutrition and Health Outcomes Associated with Food Insecurity and Hunger

This paper explores how food insecurity and hunger relate to health and nutrition outcomes in food-rich countries such as the United States. It focuses on two subgroups of the population for whom data are available: women of childbearing age and school-age children. Special consideration is given to examining how food insecurity relates to these outcomes independently of socioeconomic status and poverty. In a population-based sample of women of childbearing age, the least severe level of food insecurity (household food insecurity) was correlated with higher body mass index (BMI), controlling for other available and known influences on obesity including income level. In low income school-age children from two large urban areas of the U.S., risk of hunger and hunger were associated with compromised psychosocial functioning, controlling for maternal education and estimated household income. The nutrition and health consequences of food insecurity comprise a potentially rich area for future, socially relevant research in the field of nutritional sciences.

Development of indicators to assess hunger.

Despite widespread concern about hunger in America, efforts to monitor and assess the extent of hunger have been hampered by lack of consensus on an appropriate meaning for the term hunger and by the lack of valid indicators to assess it. The first phase of the research used qualitative methods to derive a socially-appropriate definition of hunger. Thirty-two women in Upstate New York were interviewed regarding their experience with food problems and hunger. The interviews were analyzed using the constant comparative method. Results indicated that women had a narrow and a broad concept of hunger. The narrow concept focused on going without food for a specified period of time and the physical sensation of hunger. The broad one included two dimensions: household and individual hunger. Each had quantitative, qualitative, psychological, and social components. The second phase of the research used survey methodology to examine the validity and reliability of items designed to measure the conceptual definition of hunger. The survey was administered to 189 women in Upstate New York who participated in programs designed for low-income households or households in need of food. The second phase confirmed the conceptualization of hunger developed in the first phase. A subset of valid and reliable items that represented each of the major dimensions and components of hunger was identified as being useful for monitoring and assessing hunger.

Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum

OBJECTIVES: (1) To describe the relative importance of gestational weight gain, postpartum exercise, food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum; and (2) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing.DESIGN: A prospective cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York.SUBJECTS: A total of 540 healthy adult women who gave birth to full-term singleton infants.MEASUREMENTS: Sociodemographic characteristics, exercise, food-related behaviors and breastfeeding were assessed using the medical record and a mailed questionnaire. Body weight was measured at prenatal visits and 1 y postpartum. Weight retained and major weight gain (4.55 kg) at 1 y postpartum were the main outcomes.ANALYSIS: Linear and logistic regression analyses were conducted.RESULTS: Women were on average 1.51±5.95 kg heavier at 1 y postpartum than they were in early pregnancy. Nearly 25% of women experienced a major weight gain of 4.55 kg or more at 1 y postpartum. Gestational weight gain, exercise frequency, change in food intake and breastfeeding were each significantly related to postpartum weight retention. With the exception of breastfeeding, all of these factors were also associated with major weight gain. Women under 20 y or over 40 y at delivery, and single women retained significantly more weight. Lower income women with gestational weight gains above the Institute of Medicine (IOM) range retained 3.73 kg more than lower income women who gained within the range. They were also 4.7 times more likely to experience major weight gain with childbearing. The impact of exceeding the IOM gestational weight gain guidelines was three times greater in lower income women than it was in higher income women.CONCLUSION: Gestational weight gain, postpartum exercise frequency, and food intake are significantly associated with weight change from early pregnancy to 1 y postpartum and major weight gain with childbearing. Lower income women who gain more weight in pregnancy than the IOM recommends are at high risk for major weight gain with childbearing.

Achieving a Healthy Weight Gain During Pregnancy

This review uses the 1990 U.S. Institute of Medicine (IOM) gestational weight gain recommendations to examine the question, what is a healthy pregnancy weight gain? The relationship of gestational weight gain to infant size at birth; pregnancy, labor, and delivery complications; neonatal, infant, and child outcomes; and maternal weight and health outcomes in U.S. and European populations are discussed. Pregnancy weight gains within the IOM recommendations are associated with better outcomes. The possible exception is very obese women, who may benefit from weight gains less than the 7 kg (15 pounds) recommended. Only about 33% to 40% of U.S. women gain within IOM recommendations. Excessive gestational weight gain is more prevalent than inadequate gain. Womens gestational weight gains tend to follow the recommendations of health care providers. Current interventions demonstrate efficacy in influencing gestational weight gain in low-income women with normal and overweight body mass index in the United States and obese women in Scandinavia.

Understanding Food Insecurity in the Elderly: A Conceptual Framework

Abstract In order to determine the potential effects of changes in welfare, health, and nutrition programs on food insecurity in the elderly, it is important to have a comprehensive understanding of the factors influencing food insecurity in this population group. Using a naturalistic paradigm and methods, a conceptual framework of factors that influence food insecurity status was developed based on in-depth interviews with 41 low-income rural white and urban black elderly individuals in 35 households in upstate New York.The conceptual framework depicts how several sets of factors, particularly health, food program participation, and life experiences, relate to food insecurity in the elderly. The use of several food assistance programs by low-income elderly, their views on such programs, and a unique “grocery bag” program for homebound elderly who can cook for themselves also are discussed.

Growing up poor: Long-term implications for eating patterns and body weight

This study aimed to understand how poverty-associated food deprivation in childhood contributes to the well-known relationship between low socioeconomic status (SES) in childhood and obesity in the adult years. Thirty low-income, rural women with at least one child were followed for over three years with annual semi-structured interviews collecting quantitative and qualitative data. For the quantitative portion, the measures of interest were body mass index (BMI), food insecurity, eating patterns, and SES. For the qualitative portion, text from the interviews was analyzed using the constant comparative method. Growing up in a poor household was associated with increased risk of overweight and obesity in adulthood. Experiences of poverty-associated food deprivation in childhood appeared to super-motivate some women to actively avoid food insecurity in adulthood. It also influenced the womens current food preferences. Tremendous excitement accompanied the availability of food after periods of deprivation in both the women and their children. Some women had used food to meet emotional needs in childhood and overeating had become a generalized response to negative emotional states in the adult years. Food deprivation in childhood and associated attitudes and behaviors towards food are one possible mechanism for explaining the association between childhood poverty and adult obesity.

Measures of Food Insecurity/Security

ABSTRACT Nutrition education has the potential to play an important role in ensuring food security and improving nutritional status. Therefore, food security is recommended for inclusion in nutrition education evaluation efforts. Considerable progress has been made in developing brief tools that can be used to measure food security at the household level. These tools are reliable in population-based surveys, and some studies have found that measures of food security are associated with nutrient intake. Hence, these tools can be valuable in monitoring, in community needs assessment, and in planning. These tools may also have the potential for use in evaluating nutrition education activities; this potential will be enhanced by research into the capacity of these tools to identify changes within households over time as a result of nutrition education and their sensitivity and reliability in doing so.

Parity-associated weight gain and its modification by sociodemographic and behavioral factors : a prospective analysis in US women

OBJECTIVE: To examine how the relationship between parity increase and weight gain is modified by sociodemographic and behavioral factors. DESIGN: Prospective longitudinal data from the first National Health and Nutrition Examination Survey (NHANES I, 1971–75) and its follow-up of those aged 25 y and older, the NHANES I Epidemiologic Follow-up Survey (NHEFS, 1982–84). SUBJECTS: The analytical sample was nationally representative of the United States and included 2952 white or African-American non-pregnant women aged 25–45 y at baseline, who were re-measured approximately 10 y later. MEASUREMENTS: Statistical interactions in multiple linear and logistic regression models were examined to identify how eight sociodemographic and three behavioral factors modified the effect of parity increase on body weight change and risk of substantial weight gain. RESULTS: Factors that increased parity-associated weight gain included being African-American, living in a rural area, not working outside the home, having fewer children, lower income and lower education, and being unmarried. Among white women, being younger and having higher body weight at baseline increased parity-associated weight gain, while among African-American women, being older and having lower body weight increased parity-associated weight gain. African-American smokers gained less weight with an increase in parity, while the interactions between smoking and physical activity with parity-associated weight gain in whites were complex. CONCLUSION: The effects of sociodemographic and behavioral factors on parity-associated weight gain varied by race and parity change, with the most consistent findings being that unmarried and unemployed white women had greater parity-associated weight gain, while both white and African-American women who smoked, had higher education, or higher parity had lower parity-associated weight gain. This information may contribute to better targeting and more effective interventions to prevent postpartum weight retention.

Importance of Cognitive Testing for Survey Items: An Example From Food Security Questionnaires

Abstract Cognitive testing is a useful tool for the development of questionnaire items and can also provide valuable information for the analysis and/or interpretation of preexisting survey data. This paper explains cognitive testing methods and demonstrates the benefits of cognitive testing on existing hunger, food insecurity, and food insufficiency questionnaire items. Semistructured interviews were conducted using retrospective verbal probing techniques. Each interview consisted of two parts: (1) the respondent answered a series of hunger and food insecurity items successively and (2) the interviewer engaged the respondent in a conversation that explored the meaning of the questionnaire items and the respondents answers to the items. Selected results are described to illustrate how the assessment of questionnaire items is facilitated by cognitive testing. Among other benefits, cognitive testing can clarify the meaning of specific words, determine the best item form and response categories, and help determine question meaning after a survey has been fielded. These results demonstrate that cognitive testing can be beneficial when assessing the quality of questionnaire items and determining item meaning.