Parke Wilde

Food insecurity and cognitive function in Puerto Rican adults

BACKGROUND Food insecurity is associated with nutrient inadequacy and a variety of unfavorable health outcomes. However, little is known about whether food security is associated with lower cognitive function in the elderly. OBJECTIVE We investigated the prevalence of food insecurity in a representative sample of 1358 Puerto Ricans aged 45-75 y living in Massachusetts in relation to cognitive function performances. DESIGN Food security was assessed with the US Household Food Security Scale. Cognitive function was measured to capture general cognition with a battery of 7 tests: Mini-Mental State Examination (MMSE), word list learning (verbal memory), digit span (attention), clock drawing and figure copying (visual-spatial ability), and Stroop and verbal fluency tests (fluency executive functioning). RESULTS The overall prevalence of food insecurity during the past 12 mo was 12.1%; 6.1% of the subjects reported very low food security. Food insecurity was inversely associated with global cognitive performance, as assessed by the MMSE score. The adjusted difference in the MMSE score was -0.90 (95% CI: -1.6, -0.19; P for trend = 0.003) for a comparison of participants with very low food security with those who were food secure, after adjustment for age, smoking, education, poverty status, income, acculturation, plasma homocysteine, alcohol, diabetes, and hypertension. Food insecurity was significantly associated with lower scores for word-list learning, percentage retention, letter fluency, and digit span backward tests. CONCLUSIONS Very low food security was prevalent among the study subjects and was associated with lower cognitive performance. Further studies, both observational and experimental, are warranted to clarify the direction of causality in this association.

Relationship Between Past Food Deprivation and Current Dietary Practices and Weight Status Among Cambodian Refugee Women in Lowell, MA

OBJECTIVES We investigated Cambodian refugee womens past food experiences and the relationship between those experiences and current food beliefs, dietary practices, and weight status. METHODS Focus group participants (n = 11) described past food experiences and current health-related food beliefs and behaviors. We randomly selected survey participants (n = 133) from a comprehensive list of Cambodian households in Lowell, Massachusetts. We collected height, weight, 24-hour dietary recall, food beliefs, past food experience, and demographic information. We constructed a measure of past food deprivation from focus group and survey responses. We analyzed data with multivariate logistic and linear regression models. RESULTS Participants experienced severe past food deprivation and insecurity. Those with higher past food-deprivation scores were more likely to currently report eating meat with fat (odds ratio [OR] = 1.14 for every point increase on the 9-to-27-point food-deprivation measure), and to be overweight or obese by Centers for Disease Control and Prevention (OR = 1.28) and World Health Organization (OR = 1.18) standards. CONCLUSIONS Refugees who experienced extensive food deprivation or insecurity may be more likely to engage in unhealthful eating practices and to be overweight or obese than are those who experienced less-extreme food deprivation or insecurity.

“He said, she said”: who should speak for households about experiences of food insecurity in Bangladesh?

This paper examines the extent to which males and females from the same household respond differently to household food insecurity questions, and explores the reasons for these differences and the impact for measurement. The data derive from the 2001–2003 Bangladesh Food Insecurity Measurement and Validation Study. Male and female enumerators administered the food insecurity questionnaire to women and men in the same household during three survey rounds and debriefed a subsample of men and women regarding their response discrepancies. The rate of discordance in male-female responses to individual items was examined using contingency tables. Potential explanations for the discordance were informed by the joint respondent debriefing. These hypotheses were assessed through an examination of response patterns. To assess the impact of discordance on measurement, female and male responses to a scale of 13 food insecurity items were compared and the degree of differential classification was assessed. On average the rate of discordance was 15%, but it ranged for particular items from less than 1% to upwards of 53%. Item content interacted with gender to produce discordance; women and men seemed to respond differently due to separate spheres of responsibility within the same household, power imbalances influencing intra-household food allocation, and because men seemed to take more psychological responsibility for ensuring the household food supply. Nearly one-third of households were classified in a different food security category using female versus male responses to the items. The results suggest that the household food insecurity construct is not as useful in places like Bangladesh where certain food insecurity-related manifestations are not collectively or similarly shared by members of the same living space. Individual-level measures of food insecurity are needed to complement household data, along with surveys that allow for proportionate representation of potentially vulnerable individuals with different demographic characteristics across the population.

Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot

BACKGROUND US fruit and vegetable (FV) intake remains below recommendations, particularly for low-income populations. Evidence on effectiveness of rebates in addressing this shortfall is limited. OBJECTIVE This study evaluated the USDA Healthy Incentives Pilot (HIP), which offered rebates to Supplemental Nutrition Assistance Program (SNAP) participants for purchasing targeted FVs (TFVs). DESIGN As part of a randomized controlled trial in Hampden County, Massachusetts, 7500 randomly selected SNAP households received a 30% rebate on TFVs purchased with SNAP benefits. The remaining 47,595 SNAP households in the county received usual benefits. Adults in 5076 HIP and non-HIP households were randomly sampled for telephone surveys, including 24-h dietary recall interviews. Surveys were conducted at baseline (1-3 mo before implementation) and in 2 follow-up rounds (4-6 mo and 9-11 mo after implementation). 2784 adults (1388 HIP, 1396 non-HIP) completed baseline interviews; data were analyzed for 2009 adults (72%) who also completed ≥1 follow-up interview. RESULTS Regression-adjusted mean TFV intake at follow-up was 0.24 cup-equivalents/d (95% CI: 0.13, 0.34 cup-equivalents/d) higher among HIP participants. Across all fruit and vegetables (AFVs), regression-adjusted mean intake was 0.32 cup-equivalents/d (95% CI: 0.17, 0.48 cup-equivalents/d) higher among HIP participants. The AFV-TFV difference was explained by greater intake of 100% fruit juice (0.10 cup-equivalents/d; 95% CI: 0.02, 0.17 cup-equivalents/d); juice purchases did not earn the HIP rebate. Refined grain intake was 0.43 ounce-equivalents/d lower (95% CI: -0.69, -0.16 ounce-equivalents/d) among HIP participants, possibly indicating substitution effects. Increased AFV intake and decreased refined grain intake contributed to higher Healthy Eating Index-2010 scores among HIP participants (4.7 points; 95% CI: 2.4, 7.1 points). CONCLUSIONS The HIP significantly increased FV intake among SNAP participants, closing ∼20% of the gap relative to recommendations and increasing dietary quality. More research on mechanisms of action is warranted. The HIP trial was registered at clinicaltrials.gov as NCT02651064.

The Short-Run Impact of the Healthy Incentives Pilot Program on Fruit and Vegetable Intake

In response to low consumption levels of fruits and vegetables by Supplemental Nutrition Assistance Program (SNAP) participants, the USDA Food and Nutrition Service created the Healthy Incentives Pilot (HIP) to test the efficacy of providing a 30% incentive for purchases of targeted fruits and vegetables (TFVs). Four to six months after implementation, mean daily TFV intake for adult HIP participants was 0.22 cup-equivalents higher (24% higher) than for control-group SNAP participants. These impact estimates with a random-assignment research design generally agree with previously published nonexperimental elasticity estimates, which imply that a pure price reduction of 30% would increase fruit and vegetable consumption by about 20%.

Household Food Security Is Inversely Associated with Undernutrition among Adolescents from Kilosa, Tanzania

Household food insecurity contributes to poor nutritional health, with negative consequences on growth and development during childhood. Although early childhood nutrition needs have received much attention, another important nutritional phase is adolescence. In a sample of 670 adolescents from Kilosa District, Tanzania, this study used 3 approaches to better understand the relationship between food insecurity and undernutrition. First, this study examined the associations between 3 commonly used measures of household food security and undernutrition among 670 adolescents from Kilosa District, Tanzania. The measures of household food security, energy adequacy per adult equivalent, dietary diversity score, and coping strategies index, were strongly correlated with each other and household assets (P < 0.05). Second, this study measured the nutritional status of adolescents in this district, finding a high prevalence of undernutrition (21% with BMI-for-age <5th percentile of the National Center for Health Statistics/WHO reference). Third, this study measured the association between the log odds of undernutrition (as the dependent variable) and each of the 3 measures of household food security. In separate models, household energy adequacy per adult equivalent and household dietary diversity score were inversely associated with undernutrition after adjusting for gender, age, puberty, and the interaction between age and puberty. By contrast, a greater use of coping strategies was not associated with undernutrition. Strategies focused on increasing household energy intake and improving dietary diversity among the most vulnerable households could improve the nutritional health of adolescents.

Food Stamps and Food Spending: An Engel Function Approach

Estimation of Food Stamp Program (FSP) effects has been complicated by self-selection and by a contradiction between observed spending patterns and the economic theory of consumer choice. We developed a modified version of the traditional theory, in which participant households may be partly extramarginal even if they have some cash spending on at-home food. Using Current Population Survey (CPS) data for 2001-2005, we estimated Engel functions for at-home and away-from-home food spending for FSP participants and nonparticipants. Compared to nonparticipants with the same level of total income, participants had higher at-home food spending and lower away-from-home food spending. Copyright 2007, Oxford University Press.

Food-package assignments and breastfeeding initiation before and after a change in the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND In 2009, the USDA implemented an interim rule that changed the prescribed foods in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Options for mother and infant dyads include a full breastfeeding package with no infant formula, a partial breastfeeding package with some infant formula, and a full formula package with a smaller postpartum food package for the mother. The changes were designed to encourage WIC mothers to choose breastfeeding for their infants. OBJECTIVE The purpose of this study was to measure changes in the following 3 outcomes: WIC food-package assignments, WIC infant formula amounts, and breastfeeding initiation. DESIGN We compared outcomes before and after implementation of the interim rule in a national random sample of 17 local WIC agencies (LWAs). The data source was administrative records for 206,092 dyads with an infant aged 0-5 mo in the sampled LWAs. RESULTS There were changes in WIC food-package assignments and infant formula amounts but no change in breastfeeding initiation. For dyads in whom the infant was in his or her birth month, the percentage of mothers who received the partial breastfeeding package fell from 24.7% (preimplementation) to 13.8% (postimplementation), the percentage of mothers who received the full breastfeeding package rose from 9.8% (preimplementation) to 17.1% (postimplementation), and the percentage of mothers who received the full formula package rose from 20.5% (preimplementation) to 28.5% (postimplementation). CONCLUSIONS After the change, fewer WIC mothers of new infants received the partial breastfeeding package. More WIC mothers received the full breastfeeding package, but more mothers also received the full formula package.

Designing a sustainable diet

Sustainability as dietary guidance created political debate In the United States, a vigorous debate is under way over government-issued dietary guidance. A February 2015 report by the U.S. Dietary Guidelines Advisory Committee (DGAC) recommended, for the first time, that food system sustainability be an integral part of dietary guidance in the 2015 Dietary Guidelines for Americans (DGAs) (1). With the final decision from the secretaries of Health and Human Services (HHS) and of Agriculture (USDA) about what parts of the DGAC recommendations to include in the 2015 DGAs expected at the end of this year, we discuss the need to incorporate sustainability into dietary guidelines and the political maneuvering under way to excise it.

Food Insecurity Among Cambodian Refugee Women Two Decades Post Resettlement

Resettled refugees have high rates of chronic disease, which may be partially due to persistent food insecurity. This study describes food experiences on arrival in the U.S. and current food security status and examines characteristics related to food insecurity in a well-established refugee community. Focus groups and a survey assessed food security status and personal characteristics of Cambodian women in Lowell, MA, USA. Multivariate logistic regression was used to examine relationships with food insecurity. Current rates of food insecurity are high. In multivariate models, food insecurity was positively associated with being depressed and being widowed, and negatively associated with higher income and acculturation. Early arrivers (1980s) had difficulty in the U.S. food system on arrival, while later arrivers (1990s–2000s) did not. Refugee agencies should consider strategically devoting resources to ensure successful early transition to the U.S. food environment and long-term food security of refugees.