Craig Hadley

Acculturation, economics and food insecurity among refugees resettled in the USA: a case study of West African refugees.

OBJECTIVESnTo assess the occurrence and severity of food insecurity, and examine associations between food insecurity and measures of socio-economic status and indicators of acculturation.nnnDESIGNnStructured interviews among a non-probability sample of West African refugees at baseline and 6 months follow-up. Setting Mid-sized city in north-eastern USA.nnnSUBJECTSnOne hundred and one caregivers with children under the age of 5 years and who have been living the USA for fewer than 4 years.nnnRESULTSnFood insecurity was indicated in approximately half of households (53%). The occurrence of food insecurity was associated with measures of socio-economic status such as income, employment status and participation in the Food Stamp Program (P < 0.05). Measures of acculturation such as difficulty in the shopping environment and language difficulty were also associated with the occurrence and severity of food insecurity, as was time lived in the USA (P < 0.05). Among households who had been in the USA for 1 year or less, food insecurity was indicated in 73%, whereas among households who had been in the USA for at least 3 years food insecurity was indicted in 33%.nnnCONCLUSIONSnRefugees are a potentially vulnerable group and our results echo others in suggesting a need for more thorough monitoring of the health and well-being of recently resettled refugees. These results also suggest that reliance on employment as the sole indicator of success in the resettlement process may be too narrow an indicator. Future research should focus on a wider range of measures of health and well-being.

The costs and benefits of kin

In this paper data from a Tanzanian horticultural population are used to assess whether mother’s kin network size predicts several measures of children’s health and well-being, and whether any kin effects are modified by household socioeconomic status. This hypothesis is further tested with a questionnaire on maternal attitudes towards kin. Results show small associations between measures of maternal kin network size and child mortality and children’s growth performance. Together these results suggest that kin positively influence child health, but the effects are small and it is unlikely that the high prevalence of undernutrition observed in this setting is influenced by the availability of kin.

Food Security and Child Hunger among Recently Resettled Liberian Refugees and Asylum Seekers: A Pilot Study

Little is known about the food insecurity situation among families resettled into the United States as part of the refugee resettlement program. This paper reports on a pilot study examining food insecurity among recently arrived refugee families (n=33). Objectives were to evaluate the usefulness and feasibility of methods to assess the prevalence of food insecurity and child hunger, and to examine associations between child hunger and measures of socio-economic status and measures of acculturation. Results indicated that 85% of households were food insecure, and 42% experienced child hunger. Hunger was more likely to be indicated in households using foods stamps, with lower income, and lower education. Hunger was also more likely to be indicated in households where the primary shopper experienced difficulty shopping and with language. Results are in broad agreement with those reported in other studies and highlight economic and information barriers to achieving food security. These data suggest that further study of food insecurity is warranted among recently resettled refugee communities resettled in the United States.

The Association Between Food Insecurity and Inflammation in the US Adult Population

OBJECTIVESnTo expand the understanding of potential pathways through which food insecurity is associated with adverse health outcomes, we investigated whether food insecurity is associated with nutritional levels, inflammatory response, and altered immune function.nnnMETHODSnWe performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (1999-2006) with 12,191 participants. We assessed food insecurity using the US Department of Agriculture food security scale module and measured clinical biomarkers from blood samples obtained during participants visits to mobile examination centers.nnnRESULTSnOf the study population, 21.5% was food insecure. Food insecurity was associated with higher levels of C-reactive protein (adjusted odds ratio [AOR]=1.21; 95% confidence interval [CI]=1.04, 1.40) and of white blood cell count (AOR=1.36; 95% CI=1.11, 1.67). White blood cell count partly mediated the association between food insecurity and C-reactive protein.nnnCONCLUSIONSnThese findings show that food insecurity is associated with increased inflammation, a correlate of chronic diseases. Immune response also appears to be a potential mediator in this pathway.

Hunger and health among undocumented Mexican migrants in a US urban area

OBJECTIVESnTo measure the occurrence and correlates of hunger and to evaluate the association between hunger and three health indicators among undocumented Mexican immigrants.nnnDESIGNnNon-probability cross-sectional sample.nnnSETTINGnNeighbourhoods within New York City.nnnSUBJECTSnFour hundred and thirty-one undocumented Mexican immigrants living in the USA.nnnRESULTSnHunger was indicated by approximately 28% of respondents. In a multivariate model, working as a day labourer was associated with hunger (odds ratio (OR) 3.33, 95% confidence interval (CI) 1.83-6.06) while receiving public assistance protected against hunger (OR 0.23, 95% CI 0.06-0.88). In multivariate models, respondents who reported experiencing hunger also reported poorer overall health (OR 1.69, 95% CI 0.95-3.02) and more days of poor mental (P = 0.045) and physical health (P < 0.0001). Greater amount of time lived in the USA was also associated with worse overall health (P = 0.054) and more days of poor mental and physical health (P < 0.01).nnnCONCLUSIONSnThe present study shows that food insecurity and hunger may be problems among undocumented migrants living in the USA. Uncertain and unpredictable work schedules and limited access to public assistance may contribute to high levels of hunger, which in turn may also negatively affect mental and physical health. Increasing amount of time lived in the USA is also associated with poorer health indicators. Programmes that provide undocumented migrants with emergency access to resources may reduce food insecurity and lead to improved health outcomes among this vulnerable population.

A glossary of culture in epidemiology

Culture frequently is used to explain population differences in health. This glossary defines key concepts and terms relevant to the concept of culture and describes three challenges—definitional, theoretical, and methodological—in identifying specific pathways by which culture affects health.

A new global monitoring system for food insecurity

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