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Catherine Bertini, a leader in addressing global hunger, discusses the challenges of achieving zero hunger by 2030. Currently, 800 million people are food-insecure due to poverty, conflicts, climate issues, and the COVID-19 pandemic. The goal of reaching net-zero greenhouse gas emissions by 2050 poses a challenge, as agriculture contributes a quarter of all emissions. Efforts are being made to develop climate-resilient African crops and reduce negative impacts from the agricultural industry. The text emphasizes the importance of proactive measures to mitigate the effects of climate change on food security, investing in pre-mitigation efforts, and supporting local food systems. It also highlights the role of women in food and climate issues and the recent recognition of food's importance in climate discussions. The text concludes by discussing the food situation in Gaza and the need for an end to war to ensure food delivery to the region. [Extracted from the article]

Objective: Food insecurity is a prevalent social risk among emergency department (ED) patients. Patients who may benefit from food insecurity resources may be identified via ED-based screening; however, many patients experience difficulty accessing resources after discharge. Co-locating resources in or near the ED may improve utilization by patients, but this approach remains largely unstudied. This study characterized the acceptance and use of a food voucher redeemable at a hospital food market for patients who screened positive for food insecurity during their ED visit.Methods: This prospective cohort study, conducted at a single county-funded ED, included consecutive adult patients who presented on weekdays between 8 AM–8 PM from July–October 2022 and consented to research participation. We excluded patients who required resuscitation on arrival or could not provide written informed consent in English. Study participants completed a paper version of the two-question Hunger Vital Sign screening tool, administered by research staff. Participants who screened positive received a uniquely numbered $30 food voucher redeemable at the hospital’s co-located food market. Voucher redemption was quantified through regular evaluation of market receipt records at 30-day intervals. The primary outcome was the proportion of redeemed vouchers. Secondary outcomes included the proportion of participants screening positive for food insecurity, proportion of participants accepting vouchers, and associated descriptive statistics.Results: Of the 396 eligible individuals approached, 377 (95.2%) consented and completed food insecurity screening. Most were middle-aged (median 53 years, interquartile range 30–58 years), 191 were female (50.4%), 242 were Black (63.9%), and 343 were non-Hispanic (91.0%). Of the participants, 228 (60.2%) screened positive for food insecurity and 224 received vouchers (98.2%), of which 86 were redeemed (38.4%) a median of nine days after the ED visit.Conclusion: A high proportion of participants screened positive for food insecurity and accepted food vouchers; however, less than half of all vouchers were redeemed at the co-located food market. These results imply ED food voucher distribution for food insecurity is feasible, but co-location of resources alone may be insufficient in addressing the social risk and alludes to a limited understanding of facilitators and barriers to resource utilization following ED-based social needs screening.

ObjectivesUnhealthy diets and inadequate exercise are associated with chronic health conditions and excess mortality. Older African Americans do not meet dietary and exercise guidelines, and this may have worsened during the COVID-19 pandemic due to individual and environmental factors, including food insecurity. Studies evaluating these dynamics are essential for developing interventions. This narrative details a study protocol and data collection experiences during the pandemic.MethodsParticipants > 55 years African American old completed detailed food frequency, exercise, and food access questionnaires between October 2020 and July 2021. Observations of the study administrators (authors of this manuscript) for the duration of the study are presented. Details on the study design and reflections on the opportunities, challenges, and lessons learned are summarized. Future manuscripts will report data analysis of study findings.ResultsA total of 123 older African American adults participated in the study, and 118 (70% female) completed all three questionnaires. More than 50% of the participants had at least two primary chronic conditions. About 85% were fully vaccinated against COVID-19. Applying community-based participatory approaches, leveraging partnerships, and exercising flexibility approaches were pivotal to successfully implementing the study protocol.ConclusionsDespite challenges related to the COVID-19 pandemic, detailed data on older African American adults' diet and exercise habits were obtained. Our study design and experiences will benefit future researchers. More importantly, results from our study will inform interventions and policies aimed at minimizing consequences associated with poor diet and exercise habits during the pandemic among this vulnerable population.

BackgroundSocial care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs.ObjectiveTo describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting.DesignWe used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration.SettingTwo safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs.ParticipantsSix physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N = 30) completed interviews.ResultsFour major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences.ConclusionsThe COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery.

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease among US children. Studies have associated food insecurity with MASLD in adults, but there are few studies of pediatric MASLD, particularly in high-risk populations. We assessed the impact of household food insecurity at 4 years of age on MASLD in Latinx children. METHODS: Using a prospective cohort design, Latina mothers were recruited during pregnancy and followed with their children until early to mid-childhood. Our primary exposure was household food insecurity at 4 years of age measured using the validated US Household Food Security Food Module. Our primary outcome, MASLD, was defined as alanine transaminase (ALT) ≥95th% for age/gender plus body mass index (BMI) ≥85% at time of ALT measurement (assessed between ages 5-12). We used multivariable logistic regression models to test for independent associations between household food insecurity and pediatric MASLD. RESULTS: Among 136 children, 28.7% reported household food insecurity at 4 years of age and 27.2% had MASLD in early to middle childhood. Approximately 49% of children with MASLD and 21% of children without MASLD were food insecure (p

Food insecurity is highly prevalent and linked to poorer diet and worse metabolic outcomes. Food insecurity can be stressful, and could elicit chronic psychological and physiological stress. In this study, we tested whether stress could be used to identify those at highest risk for worse diet and metabolic measures from food insecurity. Specifically, we hypothesized that cortisol (a physiological marker of stress) and perceived psychological stress would amplify the link between food insecurity and hyperpalatable food intake as well as metabolic measures. In a sample of 624 Black and White women aged 36-43 who participated in the NHLBI Growth and Health Study's midlife assessment, we assessed associations between food insecurity with hyperpalatable food intake (high fat + high sodium foods; high fat + high sugar foods; and high carbohydrate + high sodium foods), and metabolic measures (fasting glucose, insulin resistance, and waist circumference). We found that food insecurity was associated with higher levels of perceived stress (R2 = 0.09), and greater intake of high fat + high sugar (hyperpalatable) foods (R2 = 0.03). In those with higher cumulative cortisol (as indexed by hair cortisol), food insecurity was associated with higher levels of fasting glucose. Neither cortisol nor perceived stress moderated any other relationships, and neither variable functioned as a mediator in sensitivity analyses. Given these largely null findings, further research is needed to understand the role stress plays in the chronic health burdens of food insecurity.

Background: Food insecurity rates drastically increased during the COVID-19 pandemic contributing to high demand for emergency nutrition assistance. Prior research indicates emergency food distribution centers mainly offer food with limited nutritional value; since nutritional status may be worse among food insecure families, it is important to conduct research to inform policy and programmatic strategies to address both food insecurity and nutrition-related health disparities during a state of emergency.Purpose: The study objectives were to: (1) assess the nutritional environment of emergency food distribution centers in the San Joaquin Valley, CA; (2) identify challenges food distribution centers encountered during the pandemic; and (3) provide policy and programmatic recommendations to improve access to and the availability of nutritious food to low-income communities.Methods: A nutritional assessment was conducted with 19 emergency food centers in the San Joaquin Valley, California. A modified version of the valid and reliable Nutrition Environment Food Pantry Assessment Tool (NEFPAT) was self-administered by food pantries and banks during the pandemic. The six NEFPAT objectives were included, and we developed a seventh component to capture data on challenges encountered during the COVID-19 pandemic. Challenges of distribution sites were identified and differentiated by type of organization (i.e., food bank, food pantry, church).Results: A total of 19 completed site assessments from 7 counties are included in the analysis. Using the NEFPAT classification score, all were either bronze (16%) or silver (84%). Analyses were stratified by the type of emergency food organization: church (47%) or other food pantry (53%). All sites (i.e., church and other pantries) reported experiencing a decrease in volunteers and staff. However, food pantries experienced an increase in quantity of clients while church pantries struggled with client retention. Logistical challenges were also mentioned, pantries experienced inconsistent food donations. Others expressed high levels of concern about COVID-19 safety but managed to remain open by using a drive-thru distribution model and promoting social distancing with limits on the number of clients allowed inside a building at a time.Conclusion: Policy recommendations include increasing funding to smaller charitable nutrition assistance sites to support fresh produce access and funding for the implementation of nutrition policy guidelines to improve the food environment. Programmatic recommendations include the adoption for a nutrition ranking system for food pantries, implementation of nudges to improve the selection of healthier food items, and use of valid and reliable data collection instruments to inform decisions to tailor food options that are aligned with the medical/health and social needs of food pantry clients.

Food and/or housing instability (FHI) has been minimally examined in post-9/11 US veterans. A randomly selected nationally representative sample of men and women veterans (n = 38,633) from the post-9/11 US veteran population were mailed invitation letters to complete a survey on health and well-being. Principal component analysis and multivariable logistic regression were used to identify FHIs key constructs and correlates for 15,166 men and women respondents (9524 men, 5642 women). One-third of veterans reported FHI; it was significantly more likely among women than men (crude odds ratio = 1.31, 95% CI:1.21-1.41) and most prevalent post-service (64.2%). Mental Health/Stress/Trauma, Physical Health, and Substance Use were FHIs major constructs. In both sexes, significant adjusted associations (p < 0.01) were found between FHI and homelessness, depression, adverse childhood experiences, low social support, being enlisted, being non-deployed, living with seriously ill/disabled person(s), and living in dangerous neighborhoods. In men only, posttraumatic stress disorder (adjusted odds ratio (AOR) = 1.37, 95% CI:1.14-1.64), cholesterol level (elevated versus normal, AOR = 0.79, 95% CI:0.67-0.92), hypertension (AOR = 1.25, 95% CI:1.07-1.47), and illegal/street drug use (AOR = 1.28, 95% CI:1.10-1.49) were significant (p < 0.01). In women only, morbid obesity (AOR = 1.90, 95%CI:1.05-3.42) and diabetes (AOR = 1.53, 95% CI:1.06-2.20) were significant (p < 0.05). Interventions are needed that jointly target adverse food and housing, especially for post-9/11 veteran women and enlisted personnel.

BACKGROUND: Individual adverse social determinants of health are associated with increased risk of diabetes in pregnancy, but the relative influence of neighborhood or community-level social determinants of health is unknown. OBJECTIVE: This study aimed to determine whether living in neighborhoods with greater socioeconomic disadvantage, food deserts, or less walkability was associated with having pregestational diabetes and developing gestational diabetes. STUDY DESIGN: We conducted a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. Home addresses in the first trimester were geocoded at the census tract level. The exposures (modeled separately) were the following 3 neighborhood-level measures of adverse social determinants of health: (1) socioeconomic disadvantage, defined by the Area Deprivation Index and measured in tertiles from the lowest tertile (ie, least disadvantage [T1]) to the highest (ie, most disadvantage [T3]); (2) food desert, defined by the United States Department of Agriculture Food Access Research Atlas (yes/no by low income and low access criteria); and (3) less walkability, defined by the Environmental Protection Agency National Walkability Index (most walkable score [15.26-20.0] vs less walkable score [

BACKGROUND: Food insecurity and metabolic diseases both disproportionately affect Hispanic children. Cross-sectional studies have linked food insecurity with adverse cardiometabolic markers, including elevated plasma triglycerides and glucose concentrations. However, the association between changes in food insecurity and changes in cardiometabolic markers in children remains to be explored. Furthermore, few studies have assessed the impact of school-based nutrition interventions on household food insecurity. OBJECTIVE: The objectives of this study are to assess the effect of the TX Sprouts intervention on household food insecurity and to examine the association between changes in household food insecurity and changes in cardiometabolic markers over 1 academic year. METHODS: This secondary analysis used data from TX Sprouts, a cluster-randomized school-based gardening, cooking, and nutrition trial. The study enrolled 3rd-5th-grade students from 16 schools that served primarily (>50%) Hispanic families with low income in Austin, TX. Participants (n = 619) provided household food insecurity data and fasting lipid panels at both baseline and postintervention, ∼9 mo following. RESULTS: There was no intervention effect on household food insecurity. Independent of the intervention, a 1-point increase in food insecurity, indicative of becoming more food insecure, was associated with a 2.61 mg/dL increase in triglycerides (P = 0.001; 95% CI: 1.04, 4.19) at follow-up. Children who were food insecure at baseline and became food secure at follow-up had a mean 5.05 mg/dL decrease in triglycerides compared with a 7.50 mg/dL increase in triglycerides in children who remained food insecure throughout (95% CI: -23.40, -1.71, P = 0.023). There were no other associations between changes in food insecurity and cardiometabolic markers. CONCLUSION: Although the intervention did not improve food insecurity, reductions in food insecurity over 9 mo were associated with improved cardiometabolic markers in high-risk children, emphasizing the need for interventions targeting food insecurity. The study is registered at clinicaltrials.gov under NCT02668744 (https://classic. CLINICALTRIALS: gov/ct2/show/NCT02668744).

This study investigates how the landscape of sex work in Dar es Salaam, Tanzania, evolved in the context of the COVID-19 epidemic. Using a mixed-methods approach, the analysis triangulates data from quantitative and qualitative sources to quantify shifts in income, demand, and client frequency and describe female sex workers perspectives on their work environment. The COVID-19 restrictions introduced in early 2020 resulted in dramatic decreases in sex work income, leading to extreme financial vulnerability, food insecurity, and challenges in meeting other basic needs such as paying rent. However, in a 2021 follow-up survey, sex workers reported the summer of 2021 as a key turning point, with the demand for sex work rebounding to closer to pre-pandemic levels. Notably, despite the average number of unique weekly clients not yet having fully rebounded, by 2021 the price per client and the total monthly sex work income had returned to pre-pandemic levels. This may potentially be explained by an increased number of repeat clients, which represented a larger proportion of all clients during the COVID-19 pandemic.

We examined associations between adolescent self-reported hunger, health risk behaviors, and adverse experiences during the 2018-2019 school year. Youth Risk Behavior Survey data were pooled from 10 states. Prevalence ratios were calculated, and we assessed effect measure modification by sex. The prevalence of self-reported hunger was 13%. Self-reported hunger was associated with a higher prevalence of every health risk behavior/adverse experience analyzed, even after adjusting for sex, grade, and race/ethnicity. Sex did not modify associations. Findings underscore needs for longitudinal research with more robust measures of adolescent food insecurity to clarify the temporality of relationships.

In the United States, college students experience disproportionate food insecurity (FI) rates compared to the national prevalence. The experience of acute and chronic FI has been associated with negative physical and mental health outcomes in this population. This narrative review aims to summarize the current methodologies for assessing health outcomes associated with the experience of FI in college students in the United States. To date, assessing the health outcomes of FI has predominately consisted of subjective assessments, such as self-reported measures of dietary intake, perceived health status, stress, depression, anxiety, and sleep behaviors. This review, along with the emergence of FI as an international public health concern, establishes the need for novel, innovative, and objective biomarkers to evaluate the short- and long-term impacts of FI on physical and mental health outcomes in college students. The inclusion of objective biomarkers will further elucidate the relationship between FI and a multitude of health outcomes to better inform strategies for reducing the pervasiveness of FI in the United States college student population.

The relationship between food insecurity and transactional sex is well recognized, but less is known about this relationship among adolescents. We analyzed cross-sectional baseline data from 3,130 female secondary students aged 12-19 enrolled in a three-arm, cluster randomized controlled trial to examine the association between food insecurity and transactional sex. The explanatory variable was food security and the outcome was ever engaging in transactional sex. Over one quarter (28.7%) reported any food insecurity and 1.9% of all participants (9.6% of sexually active participants) reported ever engaging in transactional sex. In adjusted models, ever experiencing any food insecurity was associated with a higher prevalence of ever transactional sex (PR: 1.60; 95% CI: 1.02, 2.49) compared to little to no food insecurity. These results provide insight into potential predictors of higher-risk sexual behavior in Rwanda; they also provide policy-makers with populations with whom to intervene on upstream determinants of transactional sex, notably poverty and food insecurity.

The objective of this study was to explore the lived experiences of food insecurity amongst Bronx residents. Applying a community-based participatory research approach, we conducted a qualitative study, entailing 38 interviews with food pantry recipients, 4 key informant interviews with social service administrators, and two focus groups with 12 food pantry staff and social service providers in New York City (NYC). Applying a precarity framework, we identified three themes: (1) unaffordability of living expenses in NYC; (2) financial hardships during the COVID-19 pandemic; and (3) institutional and technological barriers to food access. We identified the following subthemes under theme one: rising food costs and high cost of living. Under theme two, we identified four subthemes: (a) large household size driving poverty for Bronx families; (b) vulnerabilities to food insecurity among older adults; (c) budgeting for reduced incomes during the COVID-19 pandemic; and (d) managing unstable employment. Under the third theme, we identified three subthemes: (a) lack of access to healthy, culturally appropriate foods; (b) need for wider service availability; (c) and not having smartphones for telehealth. Study findings demonstrate how precarity impacts the lived experiences of food insecurity and financial hardship for residents of the South Bronx during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Climate Change and food security remain one of the topical issues discussed globally. In Ghana, the literature has reported on the effects of climate change on the food consumption patterns of many households due to low adaptive capacity and inefficient food production systems. In addition to climate change as a threat to food security, funeral rites also play a major role in household food insecurity. However, the link between climate change, funeral rites and food security as indices of social vulnerability has been less investigated. Using a qualitative-dominance approach to research with 8 key informant interviews, 4 focus group discussions (FGDs) and a questionnaire, the analysis revealed that climate change and funeral rites are critical determinants of food insecurity in the Kassena Nankana Municipality of the Upper East Region of Ghana. The results show that while climate change affects the food production systems, the poorly harvested farm produce and livestock are used for the funeral rites of the deceased’s household family. While being sensitive to the cultural aspects of the uses of farm produce and livestock for funeral rites, and given the prevailing climatic conditions, the study recommends the need for traditional authorities and households to consider holding less expensive funeral rites which do not expend future food needs and resources. Again, localised climate change adaptation strategies need to be developed by the Ministry of Food and Agriculture to support the activities of agriculture in the municipality which is widely known to be susceptible to climate change. [ABSTRACT FROM AUTHOR]

This commentary explores the intersection between climate, conflict, and child nutrition, highlighting the severe child nutrition crisis in Sub-Saharan Africa exacerbated by climate change and ongoing conflicts. Shifting climate patterns disrupt agricultural productivity and food security, while persistent conflicts displace populations and destroy infrastructure, significantly increasing food insecurity and malnutrition among children. Recent UNICEF data indicates that 1 in 4 children globally live in severe food poverty, with those affected up to 50% more likely to suffer from life-threatening malnutrition. Over half a billion children reside in areas prone to climate-related extreme weather events, challenging food production, distribution, and access. Extreme weather events have led to crop failures, food shortages, and price spikes, disproportionately affecting vulnerable populations. Changes in temperature and precipitation patterns also alter the nutritional content of crops, worsening nutritional challenges. Conflicts in SSA have led to a food crisis of unprecedented scale, with over 80% of the 137 million Africans facing acute food insecurity located in conflict-affected countries. The conflict between Russia and Ukraine has further disrupted global food and fertilizer supply chains, exacerbating food shortages and inflation in many African countries. Addressing this crisis requires a multifaceted approach integrating evidence-based, cost-effective strategies. This commentary advocates for the adoption of the 3 C approach—climate-smart school feeding programs, cultivation of edible insects, and community-based food hubs—as solutions to enhance child nutrition and build climate resilience. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Adults with food insecurity (FI) face barriers to hypertension management, including difficulty adhering to diet recommendations. Few community health worker (CHW) interventions focus on diet to improve blood pressure. This qualitative study elicited patient and CHW perspectives on healthy eating and a future CHW nutrition intervention for patients with hypertension. Methods: Twenty-five patients with hypertension and FI and 5 CHWs participating in a hypertension health coaching program from 5 Boston-area health centers participated in semi-structured interviews from July to September 2023. Interviews were audio recorded, transcribed, and analyzed using the Framework Method. Results: Themes included: 1) Variable patient knowledge about dietary patterns for hypertension management and low confidence in interpreting nutrition labels; 2) Culture influenced healthy food perception; and 3) Barriers to healthy eating included cost, limited cooking abilities/supplies, and competing demands. Patients and CHWs favored simple nutrition education materials (e.g., traffic light nutrition ranking, healthy meals on a budget). Patients had mixed opinions about CHW-accompanied supermarket visits. Conclusions: This study identified culture, knowledge gaps, and budget constraints as factors influencing diet among patients with hypertension and FI. A CHW-delivered intervention could include simplified nutrition education, strategies for healthy eating on a budget, and linkage to community-based food programs. [ABSTRACT FROM AUTHOR]

Introduction: Burkina Faso implemented stringent measures in response to the COVID-19 pandemic that profoundly affected its economy and might have exacerbated food insecurity. While prior studies have assessed the impact of these measures on consumers, there is a dearth of evidence of its effects on food producers in Sub-Saharan Africa. This study aims (i) to evaluate the repercussions of COVID-19 on the possession of food production assets and on the number of livestock owned; and (ii) to determine the correlation between the food insecurity experience scale (FIES) score, ownership of these assets, and the number of livestock owned. Methods: This study employs a pre-post comparison design in two panels of randomly selected households in Burkina Faso. While Panel A was constituted of 384 households predominantly (76%) living in rural areas, Panel B comprised 504 households, only half of which (51%) lived in rural areas. All households were visited twice: in July 2019 and February 2021, for Panel A, and in February 2020 and February 2021, for Panel B. Panel B was added to the study before the pandemic thanks to additional funding; the timing of the survey was harmonized in both panels for the second round. Regression models were used with fixed effects at the household level, controlling for potential time-invariant confounding variables, and correlation coefficients between possession of production assets or number of livestock and FIES score were measured. Results: Our findings indicate that the possession of some assets in Panel A (cart, livestock, bicycle, watch) was significantly reduced during the pandemic, as was the herd sizes among livestock-owning households in both panels. Households with fewer production assets and number of livestock were more likely to experience food insecurity. Conclusion: This study underscores the vulnerability of rural households in Burkina Faso to the economic disruptions caused by the COVID-19 pandemic. Addressing the challenges faced by farming and livestock-owning households is crucial for mitigating food insecurity and improving resilience in the face of ongoing crises. [ABSTRACT FROM AUTHOR]

AbstractParticipants: A critical public health issue facing many universities is food insecurity. Food insecurity has been associated with many academic, physical, and mental health issues. Although the number of campus-based food pantries has grown exponentially, self-, and social stigma have been associated with low rates of utilization. Methods: The current quantitative study examined perceptions of food pantry stigma among food insecure college students (n = 93) who have accessed food pantry services. Results: Results reveal moderate levels of food pantry stigma with no statistically significant differences in food pantry stigma scores by level of food security (p = .322) and frequency of food pantry use (p = .263). Few participants indicated perceptions of social stigma, yet mixed results were observed regarding self-stigma. Conclusion: More research is warranted aimed at gaining a better understanding of food pantry stigma among college students that can inform campus-based interventions, practices, and policies aimed at increasing the utilization of campus-based food pantry resources. [ABSTRACT FROM AUTHOR]

Background: Government programs—targeting chronic disease patients with high health care costs—focus on clinical conditions, factors internal to the health care system, and individual patient education, not on addressing modifiable social determinants of health to reduce health care utilization. Objective: To evaluate differences in sociodemographic variables and health care utilization between patients with chronic obstructive pulmonary disease (COPD) who reported food insecurity and those who did not. Methods: This descriptive retrospective cross-sectional study used data from the electronic health records of a convenience sample of 854 participants with a discharge diagnosis of COPD or COPD with acute exacerbation, admitted via the emergency department of participating hospitals in Southern California. Chi-square (or Fisher's exact) tests and t tests were used to evaluate group differences, and multivariate (or Firth) logistic regression to identify factors that increased the odds of emergency department visits and hospitalizations. Results: Significant differences between groups were identified for food insecurity (sometimes or often vs never insecure) and age (P <.001), race (P =.022), medical insurance (P <.001), zip code (P =.022), homeless status (P <.001), smoking status (P <.001), and emergency department visits (P =.033). No significant differences were found for food insecurity and hospitalizations (P =.592). Conclusion: This study contributes to the growing body of research supporting the association of upstream social factors (food insecurity, homelessness, zip code) and downstream health outcomes (repeated emergency room visits), and how existing programs can be effectively utilized to impact downstream health outcomes such as health care utilization. [ABSTRACT FROM AUTHOR]

Background: Social care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs. Objective: To describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting. Design: We used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration. Setting: Two safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs. Participants: Six physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N = 30) completed interviews. Results: Four major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences. Conclusions: The COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery. [ABSTRACT FROM AUTHOR]

Background: Compared to traditional Medicare (TM), Medicare Advantage (MA) plans impose out-of-pocket cost limits and offer extra benefits, potentially providing financial relief for MA enrollees, especially for those with food insecurity. Objective: To examine whether the prevalence of food insecurity differs between TM and MA enrollees at baseline and then examine whether MA enrollment in a baseline year is associated with less financial hardships in the following year, relative to TM enrollment, especially for those experiencing food insecurity. Design: We conducted a retrospective longitudinal cohort study. Participants: Our analysis included 2807 Medicare beneficiaries (weighted sample size, 23,963,947) who maintained continuous enrollment in either TM or MA in both 2020 and 2021 from the Medical Expenditure Panel Survey. Main Measures: We assessed outcomes related to financial hardships in health care and non-health care domains (measured in 2021). Our primary independent variables were food insecurity and MA enrollment (measured in 2020). Results: The point estimate of food insecurity prevalence was greater among MA enrollees than TM enrollees, but the difference was not statistically significant (1.1 percentage points [95% CI, − 1.0, 3.4]). Furthermore, there is evidence that compared to TM enrollment, MA enrollment did not mitigate the risk of financial hardship, particularly for food-insecure enrollees. Rather, food-secure MA enrollees faced greater financial hardship in the following year than food-secure TM enrollees (11.2% [8.9–13.6] and 7.6% [6.9–8.3] for problems paying medical bills and 5.5% [4.6–6.4] and 2.8% [2.1–3.6] for paying medical bills over time). Moreover, the point estimate of financial hardship was higher among food-insecure MA enrollees than food-insecure TM enrollees (21.5% [5.4–37.5] and 11.2% [4.1–18.4] and 23.7% [9.6–37.9] and 6.9% [0.5–13.3]) despite the lack of statistical significance. Conclusion: These findings suggest that the promise of financial protection offered by MA plans has not been fully realized, particularly for those with food insecurity. [ABSTRACT FROM AUTHOR]

Food insecurity (FI) is associated with poor health outcomes in children, and studies have shown higher FI among children with diabetes mellitus. This study assessed provider (N = 22, 35.5% response rate) and parent/guardian (N = 207, 14.6% response rate) perspectives toward FI screening in a pediatric diabetes program. Among 22 providers, most "rarely" (54.5%) or "never" (27.3%) screened for FI although all felt that screening was at least "slightly important." Barriers included lack of time (63.6%), not remembering to screen (59.1%), lack of knowledge about how to address positive screens (45.5%), and being unsure how to screen (40.9%). Among 186 parent/guardians, only 24.1% had been asked about FI at a pediatric medical appointment, but only 8.6% disliked the idea of being asked by a medical provider at endocrinology visits. To be effective and sustainable, FI screening must fit within the visit flow, and providers need education on how to address positive screens. [ABSTRACT FROM AUTHOR]

Agriculture plays an important part in the overall growth and development of a nation. Concerns about agriculture continue to be a recalcitrant obstacle in the path of upward movement. Although agricultural yields are increased, however, low‐ and middle‐income countries still have difficulty in producing all of the required foods with the current state of agricultural technology. Smart agriculture is becoming increasingly important to the farmers as a means of ensuring optimal field growth and higher crop yield. This systematic study analysed and briefly explained the effects of using smart agriculture techniques (SATs) from a variety of countries, including China, the United States of America, Australia, India, the Philippine Islands, South Africa, Pakistan and Iran, among others. Increased climatic change resulting in abiotic stress and other harmful effects on plants have resulted in decreased productivity under traditional agricultural practices. Stats from the literature have shown that the launching of SATs has resulted in a significant increase in cotton–wheat and rice–wheat crop yields, resultantly increased incomes of the farmers. Application of SATs, including satellite remote sensing, drones, machine learning and image processing, monitoring, wireless sensor networks, IoT–based robotics, precision agriculture and agroforestry could be extremely useful in developing intelligent agricultural systems in underdeveloped and developing countries, with improved plant growth, high crop yield and ensuring food security. These technologies could help farmers by storing additional water, spraying pesticides with drones, practicing precision agriculture and employing sensors for assessing different environmental parameters. By making efficient use of these technologies, countries could be able to increase the yield of their crops, which, in turn, will contribute to the reduction of poverty and the elimination of food insecurity. [ABSTRACT FROM AUTHOR]

This study examined college students' food security status, Choose MyPlate familiarity, and confidence in preparing healthy meals using food pantry ingredients. A sample of 354 student users of a college food pantry in the US southeastern region were surveyed before using the food pantry for the first time. Of the respondents, 81.3% were food insecure, and 47% of the overall sample experienced very low food security. About one-third (37.3%) recognized MyPlate; of those, 89.4% stated intention to use MyPlate knowledge making pantry selections. Students familiar with MyPlate (P = 0.003) and intending to use MyPlate when making food selections (P = 0.02) exhibited greater confidence. Differences were not observed on the basis of food security status. These findings suggest that familiarity with simple nutritional guidelines such as MyPlate may improve students' intended food pantry selections and healthy meal selection confidence. [ABSTRACT FROM AUTHOR]

This study investigates the relationship between negative food aid shocks, which occur when food aid falls sharply, and food insecurity. I theorize that democracy levels in aid-recipient countries are a crucial moderating factor. Political leaders in democratic countries can be held accountable electorally if they fail to quickly find alternative means of keeping the public fed when faced with a negative food aid shock. Conversely, authoritarian governments lack this electoral accountability mechanism and are, therefore, less likely to take steps to offset the impacts of aid shocks. Consistent with these expectations, my empirical findings suggest that democratic leaders shore up food security in response to negative food aid shocks, in contrast to authoritarians. This study contributes to the academic literature and offers insights for development practice by providing the first analysis of aid volatility and hunger, while clarifying how a country's political system influences its ability to manage a crisis. [ABSTRACT FROM AUTHOR]

Background Food provision interventions (eg, produce/food prescriptions, food pharmacies, food voucher programs) that bridge clinic and community settings for improved nutritional health outcomes of at-risk patients have gained momentum. Little is known about the role of nutrition education and potential augmented impact on patient outcomes. Objective To describe intervention designs and outcomes of direct food provision clinic–community programs aimed at improving diabetes-related outcomes (glycated hemoglobin [HbA1c] levels) among patients with type 2 diabetes (T2DM) or prediabetes and food insecurity, and to compare nutrition education components across interventions. Methods The PubMed and Academic Search Complete databases were systematically searched for original peer-reviewed articles (published during 2011–2022) that described the impact of clinic–community food provision programs (ie, produce/food prescriptions, food pharmacies, and food voucher programs) onHbA1c values among adults diagnosed with T2DM or prediabetes and who screened positive for food insecurity or low income. Study designs, intervention approaches, program implementation, and intervention outcomes were described. Results Ten studies representing 8 distinct programs were identified. There was a high degree of variation in the studies' design, implementation, and evaluation. Across the 8 programs, 6 included nutrition education; of these, 1 used a theoretical framework, and 3 incorporated goal setting. Nutrition education covered multiple topical contents, including general nutrition knowledge, fruit and vegetable consumption, and accessing resources (eg, enrolling in the Supplemental Nutrition Assistance Program). Furthermore, the education was delivered through various formats (from 1-on-1 to group-based sessions), educators (community health workers, registered dietitians, physicians), and durations (from a single session to biweekly). All programs with a nutrition education component reported reduced participant HbA1c, and 4 demonstrated an increase in fruit and vegetable purchases or improved dietary quality. The remaining 2 programs that did not include nutrition education yielded mixed results. Conclusion The majority of programs included a nutrition education component; however, there was a high degree of heterogeneity in terms of content, educator, and duration. Patients who participated in programs that included nutrition education had consistent reductions in HbA1c. These observational trends warrant further exploration to conclusively determine the impact of nutrition education on patient outcomes participating in clinic–community food provision programs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this systematic literature review is to examine policy and practice recommendations, along with calls for future research, aimed at addressing food insecurity for community colleges across the U.S. Argument/Proposed Model: This article will provide a detailed methodology for the systematic literature review, as well as the findings gathered from a range of peer-reviewed articles on this topic. The authors analyzed six significant themes that surfaced from the current literature related to policy and practice at the federal, state, local, and institutional levels. Conclusions/Contributions: Six chief themes are discussed in-depth, including but not limited to: important tools and approaches for marketing and communications, data-driven decision-making, and the augmentation of food support with other public benefits and institutional resources. These thematic findings address the issue of food insecurity on community college campuses, and also offer a range of techniques and areas for consideration. This systematic literature review offers a compilation of policy and practice recommendations steeped in actionable strategies for researchers, policymakers, campus leaders, and practitioners alike. The strategies can be implemented and/or tailored to meet the needs and nuances of any community college population. [ABSTRACT FROM AUTHOR]

Objectives: To synthesize and appraise the evidence regarding the relationship between food insecurity and behaviours associated with dental caries development in adults and children in high‐income countries. Methods: A systematic review including observational studies assessing the association between food insecurity and selected dietary (free sugar consumption) and non‐dietary factors (tooth brushing frequency; use of fluoridated toothpaste; dental visiting; oral hygiene aids; type of toothbrush used; interdental cleaning frequency and mouthwash use) related to dental caries development in adults and children in high‐income countries. Studies specifically looking at food insecurity during the COVID‐19 pandemic were excluded. Searches were performed in MEDLINE, Embase, Global Health and Scopus from inception to 25 May 2023. Two authors screened the search results, extracted data and appraised the studies independently and in duplicate. Study quality was assessed using the Newcastle–Ottawa Scale (with modifications for cross‐sectional studies). Vote counting and harvest plots provided the basis for evidence synthesis. Results: Searches identified 880 references, which led to the inclusion of 71 studies with a total of 526 860 participants. The majority were cross‐sectional studies, conducted in the USA and reported free sugar consumption. Evidence for the association between food insecurity and free sugar intake from 4 cohort studies and 61 cross‐sectional studies including 336 585 participants was equivocal, particularly in the sugar‐sweetened beverage (SSB) consumption post‐hoc subgroup, where 20 out of 46 studies reported higher SSB consumption in food insecure individuals. There was consistent, but limited, evidence for reduced dental visiting in adults experiencing food insecurity compared to food secure adults from 3 cross‐sectional studies including 52 173 participants. The relationship between food insecurity and dental visiting in children was less clear (3 cross‐sectional studies, 138 102 participants). A single cross‐sectional study of 3275 children reported an association between food insecurity and reported failure to toothbrush the previous day. Conclusions: This review did not identify clear associations between food insecurity and behaviours commonly implicated in the development of dental caries that would explain why individuals experiencing food insecurity are more likely to have dental caries than those who have food security. There was some evidence of decreased dental visiting in adults experiencing food insecurity. Common methodological weaknesses across the evidence base related to the selection of participants or control of potentially confounding variables. Consequently, the quality of evidence for all outcomes was downgraded to very low. More research is needed to explore access to oral hygiene products and household environments conducive to habitual oral self‐care in food insecure populations. [ABSTRACT FROM AUTHOR]

The community sector performs an important function in providing emergency food relief, yet food insecurity is often a chronic issue due to poverty and social exclusion. Progressive food provision models present opportunities to improve voluntary food relief services that are dominant in many countries. Informed by research with clients indicating a preference for blended service models that go beyond food provision, two government agencies partnered with a social enterprise and academics to pilot a social supermarket model. This research article (a) briefly summarizes international evidence on social supermarkets' characteristics and offerings, (b) describes a process used to collaboratively develop a social supermarket incorporating universal access and social supports, and (c) presents a rubric defining elements of a social supermarket. Applicable to other community sector settings, the rubric emphasizes dignified access and service, plus opportunities for social support and connection, which are important elements in pathways out of food insecurity. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Peer research methodologies and methods are increasingly used in research, particularly to benefit from lived experiences.The experiences of peer researchers with severe mental illness are less common, including the impact on them of conducting peer‐led research. What the paper adds to existing knowledge: This paper shares the experience of peer research and suggests in the context of food insecurity, that it is not well understood by some healthcare professionals. What are the implications for practice: Implications include considerations around trauma‐informed care and the need for screening for food insecurity in mental healthcare settings. Research implications include providing training for peer research and needing to consider longevity of peer researcher relationships. Introduction: Food insecurity means that a person does not have access to sufficient nutritious food for normal growth and health. This can lead to health problems such as obesity, heart disease, diabetes and other long term chronic health conditions. People living with a severe mental illness are more likely to experience food insecurity than people without a severe mental illness. Aim: The aim of this paper is to present a lived experience narrative of two peer researchers. Peer researchers conducted interviews with adults with severe mental illness from Northern England as part of a funded research project. These interviews discussed experiences of food insecurity and strategies to tackle it and were conducted between March and December 2022. Thesis: The following paper does not discuss the results of the interviews themselves. Rather the narrative begins with an overview of peer research, before sharing the experiences of the two peer researchers in undertaking this project. Implications for Practice: This includes healthcare professionals understanding food insecurity, what it is and what it is not, thinking about trauma‐informed care, and screening for food insecurity. Peer research implications centre on adequate support and training, considerations to longevity of peer research relationships and reducing unnecessary research burden for peer researchers. [ABSTRACT FROM AUTHOR]

The Supplemental Nutrition Assistance Program (SNAP) has been established to reduce food insecurity. Limited evidence is available on SNAP participation status over time and depressive symptoms. We aimed to examine the associations of SNAP status over time among low-income individuals, with depressive symptoms in the U.S. NHANES participants aged ≥20 years of low family income from 2011 to 2018 with information available on depressive symptoms and SNAP use were included in analysis. Depressive symptoms were assessed using 9-item Patient Health Questionnaire (PHQ-9), and PHQ-9 score ≥ 10 is indicative of significant depressive symptoms. Multivariable linear and logistic regressions models were conducted to examine the associations of SNAP participation status over time (never receiving SNAP, receiving SNAP prior to >12 months ago, current receiving SNAP, receiving SNAP in the last 12 months but not currently) with depressive symptoms and significant depressive symptoms. Currently receiving SNAP (beta (β) = 0.17, 95 % CI: 0.10, 0.25; odds ratio (OR) = 1.52, 95 % confidence interval (CI): 1.16, 2.00) and receiving SNAP in the last 12 months but not currently (β = 0.24, 95 % CI: 0.04, 0.43; OR = 1.83, 95 % CI: 1.16, 2.89) were associated with higher depressive symptoms and higher prevalence of significant depressive symptoms. The cross-sectional design precludes causal interpretation, and key variables were measured with self-report. Receiving SNAP in the last 12 months was associated with higher levels of depressive symptoms among individuals with low family income. Improvement on diet quality may be important for reducing depressive symptoms among SNAP users. • Recent SNAP participation is associated with higher levels of depressive symptoms among individuals with low family income. • The associations of SNAP participation status and depressive symptoms are more pronounced in certain subgroups. • Future efforts may study improving quality of diet among SNAP recipients for further prevention of health outcomes. [ABSTRACT FROM AUTHOR]

This study investigated community empowerment as a means of addressing food insecurity amongst underserved neighborhoods by increasing available and affordable food choices through Clementine Collective stands in Staten Island, New York (Richmond County), one of the 5 Boroughs of New York City. Given the growing complexity of food insecurity, inclusive and equitable action must be taken that incorporates the voices, perspectives and needs of those most impacted. Through methods of community engagement and empowerment, the Clementine Collective collaborates with local community residents to introduce sustainable solutions that address food insecurity. A survey (N = 132) was administered to customers of a Clementine Collective stand, located in Staten Island, that assessed customers' food habits and attitudes towards their food environment and solutions. The stand was placed in a local meat market grocery store. Descriptive statistics suggested that residents recognized gaps in their food environment and were empowered to advocate for solutions. Engaging residents from their food environment to advocate for local solutions, such as at community bodegas, or small grocery stores, may be an effective method of addressing food insecurity. [ABSTRACT FROM AUTHOR]

Better diet quality regardless of community food access was associated with a higher likelihood of glycemic control in early pregnancy among nulliparous individuals with pregestational diabetes. These findings highlight the need for interventions that address nutrition insecurity for pregnant individuals living with diabetes. • Better diet quality was associated with glycemic control in early pregnancy among nulliparous individuals with pregestational diabetes. • Community food access was not associated with glycemic control. • Interventions that address nutrition insecurity for pregnant individuals living with diabetes are needed. [ABSTRACT FROM AUTHOR]

Background and Objectives: It is recognized that development in the 0-to-5-year period is predictive of lifelong health and well-being and that early childhood development is influenced by parental mental health. Social stressors such as food insecurity can exacerbate parental mental health issues. Methods: To improve understanding of this complex interplay, a primary care pediatric practice designed an innovative meal and grocery delivery program for families experiencing food insecurity with at least one child aged 0-5 years. As part of the program, food insecurity, parental mental health, and child development were assessed. Results: Food insecurity was found to be correlated with increased stress in the parent-child system, and increased stress was found to be strongly correlated with delays in early childhood developmental progress. Conclusions: These findings suggest that changes in the parent--child relationship resulting from increased parental stress due to food insecurity can play a role in influencing early childhood development. [ABSTRACT FROM AUTHOR]

Environmental justice is essential for improved quality of life and sustainable wellbeing. This study examines how environmental issues and related injustices are surfacing in U.S. social work practice and social work readiness to respond, and what resources social workers are most interested in. Data are from an online survey of U.S. social workers (N = 337) in Colorado, Ohio, and Tennessee. Participants answered questions about their social work background, current job, environmental issues in practice, resources, and demographics. Data were analyzed with descriptive statistics. For nine issues, at least 30% of participants reported these as surfacing sometimes or often, with the highest being poor food access (74.7%), extreme cold (58.8%), and poor green space access (43.9%). The extent varied by years of experience, job setting, and practice level. Meanwhile, fewer than 40% of social workers indicated that they were somewhat or very prepared to respond to eight out of nine issues. Interest was higher in the resources that could be used for responding to specific topics rather than environmental justice broadly. In addition to strengthening social work education regarding environmental justice, this study suggests that national, state, and local social work associations can—in partnership with growing numbers of social work scholars working on environmental justice—create and provide training, templates, and guidance for practitioners that are tailored to specific environmental justice issues. [ABSTRACT FROM AUTHOR]

Background/Objectives: School meals are an important source of nutrition for children and have been found to help mitigate food insecurity. This study evaluated the association between food insecurity and school meal participation and whether parental perceptions about school meals differ by food security status. Methods: In May 2022, 1110 Californian parents of K-12 students shared their perceptions about school meals, including meal quality, healthiness, stigma, and benefits, as well as their child's participation in school meals, in an online survey. Household food security was determined using the USDA 6-item module. Logistic and Poisson regression models were used for analysis. Results: The prevalence of household food insecurity was 56.2% (69.6% in households of students eligible for free meals, 55.9% in reduced-price, and 38.3% in non-eligible). Many of the reported benefits of school meals (saving families money and time) were equally highly endorsed by parents with and without food insecurity (p > 0.05). Parents reporting food insecurity had less favorable perceptions of school meals and perceived more stigma (p < 0.05). Food insecurity was positively associated with breakfast participation, especially among elementary school students and students not eligible for free or reduced-price meals (FRPMs) (p < 0.05). Conclusions: Food insecurity is prevalent among California families with school-age children, even in families not eligible for federal FRPMs. Food-insecure households have more negative perceptions of school meals and experience more stigma, though they also report higher breakfast participation. Improving school meal quality and appeal, ensuring parents are familiar with meal quality and healthfulness, and reducing stigma may ease food insecurity while improving children's health. [ABSTRACT FROM AUTHOR]

Background: Climate change adversely affects Africa's agriculture which would worsen the widespread food insecurity and nutritional deficiencies. Vulnerable populations, especially female farmers, women, and children are disproportionately affected. Methods: The paper synthesizes available peer-reviewed and grey literature on the intersections of climate change, food insecurity, agriculture, gender disparities, health, child nutrition, and micronutrient deficiencies in Africa. It explores the economic ramifications of these factors, particularly their impact on public health and economic stability. The work aggregates insights into the current and future challenges of agricultural sustainability and the expected human capital development and economic costs of climate variations. Results: The prevalence of hunger and undernourishment in Africa is notably higher compared to other regions. Climate change directly threatens agriculture, with anticipated reductions in crop and livestock yields, compounded by the negative impact of greenhouse emissions on the nutritional quality of staple foods. Female farmers contribute notably to agriculture, but their labor share is less dominant than previously assumed. Exposure to high temperatures, especially for outdoor workers and pregnant women, presents significant health risks, further impacting agricultural and economic output. These interdependencies are presented in a framework along with suggested interventions that could be contextualized to address the climate drivers and interconnectivity across agriculture, health, and livelihoods. Conclusion: The interdependence between food, agriculture, health, nutrition, and human productivity, all of which are exacerbated by the impacts of climate change in Africa, form a complex challenge with profound health and economic implications. A multifaceted strategy is needed, encompassing climate-resilient farming practices, gender-sensitive interventions, health-focused measures like micronutrient supplementation, and comprehensive economic policies. [ABSTRACT FROM AUTHOR]

The UN's Sustainable Development Goal (SDG) 12 seeks to achieve sustainable food production and consumption, including reduced food loss and waste; SDG 2 proposes the goal of zero hunger. In pursuit of these goals, technology arguably has a central role, at every level of the food value chain. To establish this role, the authors identify and examine current technologies aimed at increasing food production and suitably redistributing unused food, as tactics to combat food loss and waste, with the shared end goal of reducing food insecurity. A proposed 2 × 2 typology illustrates how existing technologies can influence food production, distribution, and consumption, as well as influence the stakeholders in the food production–consumption chain. These insights also inform a research and development agenda pertaining to the need for technology applications that can increase food production and/or reduce food waste effectively enough to achieve the goal of zero hunger. [ABSTRACT FROM AUTHOR]

We sought to evaluate the acceptability and feasibility of a culturally tailored food box intervention for improving blood pressure (BP), food security and Body Mass Index (BMI) among Chickasaw Nation adults with uncontrolled hypertension. As part of the Chickasaw Healthy Eating Environments Research Study (CHEERS), we administered a group randomized pilot study in four tribal communities (two intervention, two control). Participants in the intervention communities received six heart-healthy food boxes, culturally tailored to traditional Chickasaw diet and current food context. Outcomes were measured over 6 months. We enrolled 262 participants, and 204 with complete data on key variables were included in the analysis. The food boxes were very popular, and we achieved high retention for follow-up data collection. Intervention community participants had 2.6 mmHg lower mean systolic BP and improved diet quality and BMI compared with control participants, although, as expected for a pilot study, the differences were not statistically significant. The culturally tailored diet intervention and randomized trial study design were acceptable and feasible for Chickasaw Nation adults with uncontrolled hypertension. Our findings support the value of tribal-food bank partnerships as a potential approach for reducing food insecurity and hypertension-related disparities in Native American communities. [ABSTRACT FROM AUTHOR]

Background: Mental health outcomes can be influenced by various factors, one of which has recently gained attention, namely food security. Food security is paramount to maintaining not only physical, but also mental health. There is an increasing need to understand the interplay between food insecurity (FI) and mental health outcomes, especially among vulnerable populations. The objective of this study was to investigate the effect of FI on psychological health (anxiety and depression) as well as to examine the modifying effect of socioeconomic position on this relationship. Methods: A cross-sectional study was conducted in Maputo City, Mozambique, in 1,842 participants. Data were collected through structured interviews using a modified version of the US Department of Agriculture Household Food Security Module to measure FI, and the Hospital Anxiety and Depression Scale to measure anxiety and depression. A composite variable for psychological health was created. Propensity score matching and interaction effect analyses were employed to examine the effects of FI on psychological health and the moderating role of socioeconomic position. Results: Of the 1,174 participants randomly assigned to propensity score matching, 787 were exposed to FI while 387 were unexposed. The analysis revealed stark disparities in psychological health outcomes associated with FI. The risk of poor psychological health among those exposed to FI was 25.79%, which was significantly higher than the 0.26% in unexposed individuals. The risk difference was 25.54% points (95% CI: 22.44–28.63), with a risk ratio of 99.82. Our assessment of population attributable fractions indicated that nearly all the risk for poor psychological health in the exposed group could be ascribed to FI. The interaction effects analysis revealed that socioeconomic status modifies this relationship. Specifically, heads of food-insecure households with a lower socioeconomic position tended to report poor mental health compared to their food-secure counterparts with a higher position. Conclusions: The findings underscore the profound impact of FI on the mental health of household heads in Maputo City, socioeconomic position being a significant modifier. Addressing household FI along with the socioeconomic position of household heads could be pivotal to mental health promotion, especially among vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: Data on the association between food insecurity and depression in single parents in low- and middle-income countries (LMICs) are limited, and no study has reported the serial mediation effects of psychosocial factors in this association. This study examines the extent to which anxiety and sleep serially explain the food insecurity and depression link among single parents in Ghana. Methods: Data on 627 single parents were obtained through a multi-stage stratified sampling technique. Food insecurity was assessed using the Food and Agriculture Organization Food Insecurity Experience Scale (FIES), and depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D-10). Multivariable OLS models and bootstrapping serial mediation analyses were performed to evaluate the hypothesized associations. Results: The mean age (SD) was 45.0 (14.7) years; 67.3% females. After full adjustment, food insecurity was significantly associated with increases in anxiety symptoms (β = 0.61, 95%CI = 0.476 − 0.737), sleep problems (β = 0.04, 95%CI = 0.02 − 0.07), and depression (β = 0.24, 95%CI = 0.12 − 0.36). Food insecurity indirectly related to depression via anxiety (β = 0.35, 95%CI = 0.26-0.44) representing 55.8%, sleep (β = 0.03, 95%CI = 0.0032-0.0575) suggesting 4.0%, and anxiety→sleep (β = 0.013, 95%CI = 0.0024-0.0265) yielding 2.0% of the total effect. Conclusions: Food insecurity was positively associated with depression. This association was partially and serially explained by generalized anxiety and sleep problems. Efforts to address depression among single parents should consider interventions for food insecurity and psychosocial problems, particularly in LMICs. [ABSTRACT FROM AUTHOR]

Background: Poor psychological well-being, including depression, anxiety, and low self-esteem, is both prevalent among young South Africans living with HIV and associated with poor HIV clinical outcomes. By impacting food insecurity and employment, the COVID-19 pandemic may have influenced psychological well-being in this population. This analysis sought to examine whether food insecurity and unemployment mediated the relationship between study cohort (pre- versus during-pandemic) and psychological well-being in our sample of young South Africans living with HIV. Methods: This was a secondary analysis comparing baseline data from two cohorts of young South Africans ages 18–24 from the Cape Town and East London metro areas who tested positive for HIV at clinics (or mobile clinics) either before or during the COVID-19 pandemic. Baseline sociodemographic, economic, and psychological outcomes were analyzed through a series of bivariate logistic regression and mediation analyses. All data were analyzed in 2023 and 2024. Results: Reported food anxiety, insufficient food quality, and insufficient food quantity were lower in the cohort recruited during the COVID-19 pandemic than those recruited before the pandemic (p < 0.001). Higher levels of food insecurity predicted higher depressive and anxiety symptoms and lower self-esteem. Food anxiety, insufficient food quality, and insufficient food quantity, but not unemployment, mediated the relationship between study cohort and depressive symptoms, anxiety symptoms, and self-esteem. Conclusion: Food insecurity may have decreased amongst our sample of young people during the COVID-19 pandemic. Our findings build on our understanding of how the psychological well-being of young people living with HIV was affected by the COVID-19 pandemic and may lend support to interventions targeting food insecurity to improve psychological well-being in this population. [ABSTRACT FROM AUTHOR]

We aimed to assess the associations between sociodemographic, mental, and physical health factors and incident depressive symptoms (IDS) among ageing men and women in rural South Africa over time. Data from the 7-year South African longitudinal Health and Ageing in Africa INDEPTH Community study (HAALSI: 2015–2022) were used in the analysis (study sample: n = 3 122, aged 40 and older). The proportion of IDS was in 28.2% in 2019 and 30.0% in 2022 among men, and 30.3% in 2019 and 2022 among women. Among men, the adjusted model indicated that older age, food insecurity, poor life satisfaction, physical pain, functional disability, diabetes, kidney disease, anaemia, and obesity were positively associated, and hypertension was negatively associated with IDS. Among women, food insecurity, poor life satisfaction, physical pain, and diabetes were positively associated, and current smokeless tobacco use was negatively associated with IDS. By sex, a high proportion of IDS were found, as was the prevalence of food insecurity, poor life satisfaction, physical pain, and diabetes associated with IDS. Among older men only, older age, functional disability, kidney disease, anaemia, and obesity, but not hypertension were associated with higher odds for IDS. Among older women, only current smokeless tobacco use was negatively associated with IDS. Interventions addressing the risk for depression should consider specific sex differences. [ABSTRACT FROM AUTHOR]

The second Sustainable Development Goal of Zero Hunger, defined by the United Nations, broadly focuses on several dimensions of food access and availability, including measures of hunger and undernourishment, food insecurity, and malnutrition. Progress toward the Zero Hunger goal is monitored using indicators like the Prevalence of Undernourishment and the prevalence of moderate or severe food insecurity. These indicators are widely regarded as accurately portraying the underlying phenomena of concern. There are, however, other considerations one may want to include when considering the broader food system, including the role of food access and sovereignty in the rural areas of low-income countries. This paper reviews measurements of food insecurity and reflects on how food access and sovereignty may improve food security and, conversely, how it may impede advances toward alleviating food insecurity. These considerations can be helpful in tracking the need and progress toward the Sustainable Development Goal of Zero Hunger. [ABSTRACT FROM AUTHOR]