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Additional file 3. Example Facebook advertisement.

Additional file 2. Checklist for Reporting Results of Internet E-Surveys (CHERRIES).

Bivariate correlations between child eating behaviours and maternal feeding practices (N = 207). (DOCX 21 kb)

Overview of constructs assessed in Study 1, including their respective items, response scales and internal reliability. (DOCX 19Â kb)

Factors and corresponding items of the Feeding Practices and Structure Questionnaire (FPSQ-28) with an additional item measuring family meal setting. (DOCX 16 kb)

Purpose: Food insecurity is a major public health concern, especially in families with children. Hunger can influence the healthy development of the child and has also been shown to be associated with other determinants of child health, such as violence within the family and maternal (mental) health. While the majority of research has been conducted in high income countries with vulnerable populations, less is known about the circumstances in low-and-middle-income countries in Southeastern Europe. This study explored the experience of hunger in vulnerable families in FYR Macedonia, Republic of Moldova and Romania, and examined relationships with maltreatment and other health indicators. Methods: Data from the feasibility phase of the RISE study was used. Families (N=140) in the three countries were recruited for a parenting intervention targeting child behavioural problems. Participants reported on three hunger questions (In the past 30 days, did you ‘run out of money to buy food for your home’, ‘cut the size of meals or skip any meals because there is not enough food in the house’, ‘or any of your children go to bed hungry because there is not enough food to eat’?); household assets; child and family maltreatment; and parental health. Results: Overall, 31% of families experienced at least one form of hunger in the last month. Hunger was significantly related to other indicators of low SES such as lower adult educational and literacy level, more children in the household, and lack of household assets (5% had no access to water, 9% had no fridge). Worse family functioning (e.g. cannot turn to each other for support in crisis), current intimate partner violence (victimisation and perpetration), and more instances of child neglect were significantly associated with family hunger. In families experiencing hunger, mothers showed significantly higher scores on depressive symptoms, anxiety, stress, lower emotional support, and worse general health. Conclusions: Results indicated that hunger in families with children showing elevated child behavioural problems in Southeastern Europe was associated with more family maltreatment and poorer (mental) health. In adapting parenting interventions to address child behaviour problems, hunger and its association with health and violence should be considered.

Purpose: Food insecurity is a major public health concern, especially in families with children. Hunger can influence the healthy development of the child and has also been shown to be associated with other determinants of child health, such as violence within the family and maternal (mental) health. While the majority of research has been conducted in high income countries with vulnerable populations, less is known about the circumstances in low-and-middle-income countries in Southeastern Europe. This study explored the experience of hunger in vulnerable families in FYR Macedonia, Republic of Moldova and Romania, and examined relationships with maltreatment and other health indicators. Methods: Data from the feasibility phase of the RISE study was used. Families (N=140) in the three countries were recruited for a parenting intervention targeting child behavioural problems. Participants reported on three hunger questions (In the past 30 days, did you ‘run out of money to buy food for your home’, ‘cut the size of meals or skip any meals because there is not enough food in the house’, ‘or any of your children go to bed hungry because there is not enough food to eat’?); household assets; child and family maltreatment; and parental health. Results: Overall, 31% of families experienced at least one form of hunger in the last month. Hunger was significantly related to other indicators of low SES such as lower adult educational and literacy level, more children in the household, and lack of household assets (5% had no access to water, 9% had no fridge). Worse family functioning (e.g. cannot turn to each other for support in crisis), current intimate partner violence (victimisation and perpetration), and more instances of child neglect were significantly associated with family hunger. In families experiencing hunger, mothers showed significantly higher scores on depressive symptoms, anxiety, stress, lower emotional support, and worse general health. Conclusions: Results indicated that hunger in families with children showing elevated child behavioural problems in Southeastern Europe was associated with more family maltreatment and poorer (mental) health. In adapting parenting interventions to address child behaviour problems, hunger and its association with health and violence should be considered.&nbsp