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Health Professions â€ș General Health Professions

Food Security and Health in Diverse Populations

Works Count: 79635

Description

This cluster of papers explores the impact of food insecurity on health outcomes, focusing on the association between food insecurity and chronic diseases, mental health, nutritional consequences, and children's health. It also examines the role of social determinants and public assistance in addressing household food security among low-income families.

Keywords

Food Insecurity; Health Outcomes; Social Determinants; Nutritional Consequences; Household Food Security; Low-Income Families; Mental Health; Chronic Disease; Children's Health; Public Assistance

Clinical Epidemiology: The Essentials.

1991-05-01
Robert H. Fletcher , Suzanne W. Fletcher , Grant Fletcher
Now in its Fifth Edition, Clinical Epidemiology: The Essentials is a comprehensive, concise, and clinically oriented introduction to the subject of epidemiology. Written by expert educators, this text introduces students 
 Now in its Fifth Edition, Clinical Epidemiology: The Essentials is a comprehensive, concise, and clinically oriented introduction to the subject of epidemiology. Written by expert educators, this text introduces students to the principles of evidence-based medicine that will help them develop and apply methods of clinical observation in order to form accurate conclusions. The Fifth Edition includes more complete coverage of systematic reviews and knowledge management, as well as other key topics such as abnormality, diagnosis, frequency and risk, prognosis, treatment, prevention, chance, studying cases and cause.

Analysis of Health Surveys

2001-05-01
Barry I. Graubard , Edward L. Korn
Basic Survey Methodology. Statistical Analysis with Survey Data. Sample Weights and Imputation. Additional Issues in Variance Estimation. Cross--Sectional Analyses. Analysis of Longitudinal Surveys. Analyses Using Multiple Surveys. Population--Based Case--Control Studies. 
 Basic Survey Methodology. Statistical Analysis with Survey Data. Sample Weights and Imputation. Additional Issues in Variance Estimation. Cross--Sectional Analyses. Analysis of Longitudinal Surveys. Analyses Using Multiple Surveys. Population--Based Case--Control Studies. Appendices. References. Indexes.

Levels of racism: a theoretic framework and a gardener's tale

2000-08-01
C P Jones
The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized. This framework is useful for raising new hypotheses about the basis of race-associated 
 The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized. This framework is useful for raising new hypotheses about the basis of race-associated differences in health outcomes, as well as for designing effective interventions to eliminate those differences. She then presents an allegory about a gardener with 2 flower boxes, rich and poor soil, and red and pink flowers. This allegory illustrates the relationship between the 3 levels of racism and may guide our thinking about how to intervene to mitigate the impacts of racism on health. It may also serve as a tool for starting a national conversation on racism.
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The health of Hispanics in the southwestern United States: an epidemiologic paradox.

1986-05-01
Kyriakos Markides , Jeannine Coreil
Recent reports in the literature on the health status of southwestern Hispanics, most of whom are Mexican Americans, are reviewed critically. The review is organized into the following sections: infant 
 Recent reports in the literature on the health status of southwestern Hispanics, most of whom are Mexican Americans, are reviewed critically. The review is organized into the following sections: infant mortality, mortality at other ages, cardiovascular diseases, cancer, diabetes, other diseases, interview data on physical health, and mental health. Despite methodological limitations of much of the research, it can be concluded with some certainty that the health status of Hispanics in the Southwest is much more similar to the health status of other whites than that of blacks although socioeconomically, the status of Hispanics is closer to that of blacks. This observation is supported by evidence on such key health indicators as infant mortality, life-expectancy, mortality from cardiovascular diseases, mortality from major types of cancer, and measures of functional health. On other health indicators, such as diabetes and infectious and parasitic diseases, Hispanics appear to be clearly disadvantaged relative to other whites. Factors explaining the relative advantages or disadvantages of Hispanics include cultural practices, family supports, selective migration, diet, and genetic heritage. The recently completed Hispanic Health and Nutrition Examination Survey will go a long way to provide answers to many questions regarding the health of Hispanics in the Southwest or elsewhere.

Methodology of the Youth Risk Behavior Surveillance System

2004-01-01
Nancy D. Brener , Laura Kann , Shari L. Shanklin +4 more
Priority health-risk behaviors (i.e., interrelated and preventable behaviors that contribute to the leading causes of morbidity and mortality among youths and adults) often are established during childhood and adolescence and 
 Priority health-risk behaviors (i.e., interrelated and preventable behaviors that contribute to the leading causes of morbidity and mortality among youths and adults) often are established during childhood and adolescence and extend into adulthood. The Youth Risk Behavior Surveillance System (YRBSS), established in 1991, monitors six categories of priority health-risk behaviors among youths and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) sexual behaviors that contribute to human immunodeficiency virus (HIV) infection, other sexually transmitted diseases, and unintended pregnancy; 3) tobacco use; 4) alcohol and other drug use; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma among this population. YRBSS data are obtained from multiple sources including a national school-based survey conducted by CDC as well as schoolbased state, territorial, tribal, and large urban school district surveys conducted by education and health agencies. These surveys have been conducted biennially since 1991 and include representative samples of students in grades 9-12. In 2004, a description of the YRBSS methodology was published (CDC. Methodology of the Youth Risk Behavior Surveillance System. MMWR 2004;53 [No RR-12]). Since 2004, improvements have been made to YRBSS, including increases in coverage and expanded technical assistance.This report describes these changes and updates earlier descriptions of the system, including questionnaire content; operational procedures; sampling, weighting, and response rates; data-collection protocols; data-processing procedures; reports and publications; and data quality. This report also includes results of methods studies that systematically examined how different survey procedures affect prevalence estimates. YRBSS continues to evolve to meet the needs of CDC and other data users through the ongoing revision of the questionnaire, the addition of new populations, and the development of innovative methods for data collection.

Acculturation: Advances in theory, measurement, and applied research.

2003-01-01
Kevin M. Chun , Pamela Balls Organista , Gerardo MarĂ­n
Conceptual Approaches to Acculturation, John W. Berry Major Approaches to the Measurement of Acculturation Among Ethnic Minority Populations - A Content Analysis and an Alternative Empirical Strategy, Nolan Zane, Winnie 
 Conceptual Approaches to Acculturation, John W. Berry Major Approaches to the Measurement of Acculturation Among Ethnic Minority Populations - A Content Analysis and an Alternative Empirical Strategy, Nolan Zane, Winnie Mak Ethnic Identity and Acculturation, Jean S. Phinney Acculturation and Changes in Cutlural Values, Gerardo Marin, Raymond J. Gamba Acculturation Among Ethnic Minority Families, Kevin M. Chun, Phillip K. Akutsu The Influence of Acculturation Processes on the Family, Daniel A. Santisteban, Victoria B. Mitrani Overview of the Relation Between Acculturation and Ethnic Minority Mental Health, Pamela Balls Organista, Kurt C. Organista, Karen Kurasaki Acculturation and Physical Health in Racial/Ethnic Minorities, Hector F. Myers, Norma Rodriguez Acculturation, Psychological Distress and Alcohol Use - Investigating the Effects of Ethnic Identity and Religiosity, Fang Gong, David T. Takuchi, Pauline Agbayani-Siewert, Leo Tacata Idioms of Distress, Acculturation and Depression - the Puerto Rican Experience, Dharma E. Cortes Acculturation, Alcohol Consumption, Smoking and Drug Use Among Hispanics, Raul Caetano, Catherine L. Clark.

THE MEASUREMENT OF SOCIAL CLASS IN EPIDEMIOLOGY

1988-01-01
Penny Liberatos , Bruce G. Link , Jennifer L. Kelsey
Journal Article THE MEASUREMENT OF SOCIAL CLASS IN EPIDEMIOLOGY Get access PENNY LIBERATOS, PENNY LIBERATOS 1Division of Sociomedical Sciences, Columbia University School of Public Health600 West 168th Street, New York, 
 Journal Article THE MEASUREMENT OF SOCIAL CLASS IN EPIDEMIOLOGY Get access PENNY LIBERATOS, PENNY LIBERATOS 1Division of Sociomedical Sciences, Columbia University School of Public Health600 West 168th Street, New York, NY 10032 Reprint requests to Penny Liberatos Search for other works by this author on: Oxford Academic PubMed Google Scholar BRUCE G. LINK, BRUCE G. LINK 2Division of Epidemiology, Columbia University School of Public HealthNew York, NY Search for other works by this author on: Oxford Academic PubMed Google Scholar JENNIFER L. KELSEY JENNIFER L. KELSEY 2Division of Epidemiology, Columbia University School of Public HealthNew York, NY Search for other works by this author on: Oxford Academic PubMed Google Scholar Epidemiologic Reviews, Volume 10, Issue 1, 1988, Pages 87–121, https://doi.org/10.1093/oxfordjournals.epirev.a036030 Published: 01 March 1988

Evidence-Based Public Health: Moving Beyond Randomized Trials

2004-03-01
CĂ©sar G. Victora , Jean‐Pierre Habicht , Jennifer Bryce
Randomized controlled trials (RCTs) are essential for evaluating the efficacy of clinical interventions, where the causal chain between the agent and the outcome is relatively short and simple and where 
 Randomized controlled trials (RCTs) are essential for evaluating the efficacy of clinical interventions, where the causal chain between the agent and the outcome is relatively short and simple and where results may be safely extrapolated to other settings. However, causal chains in public health interventions are complex, making RCT results subject to effect modification in different populations. Both the internal and external validity of RCT findings can be greatly enhanced by observational studies using adequacy or plausibility designs. For evaluating large-scale interventions, studies with plausibility designs are often the only feasible option and may provide valid evidence of impact. There is an urgent need to develop evaluation standards and protocols for use in circumstances where RCTs are not appropriate.

Estimating Mediated Effects in Prevention Studies

1993-04-01
David P. MacKinnon , James H. Dwyer
The purpose of this article is to describe statistical procedures to assess how prevention and intervention programs achieve their effects. The analyses require the measurement of intervening or mediating variables 
 The purpose of this article is to describe statistical procedures to assess how prevention and intervention programs achieve their effects. The analyses require the measurement of intervening or mediating variables hypothesized to represent the causal mechanism by which the prevention program achieves its effects. Methods to estimate mediation are illustrated in the evaluation of a health promotion program designed to reduce dietary cholesterol and a school-based drug prevention program. The methods are relatively easy to apply and the information gained from such analyses should add to our understanding of prevention.

The White Man's Burden

2006-06-01
William Easterly

National Health Surveys and the Behavioral Model of Health Services Use

2008-06-23
Ronald Max Andersen
National health surveys have played an important role in the development of health services research. They have contributed to the advancement of concepts, methods, and the policy relevance of the 
 National health surveys have played an important role in the development of health services research. They have contributed to the advancement of concepts, methods, and the policy relevance of the field. One product of these surveys was the Behavioral Model of Health Services Use. This article documents a 75-year legacy by reviewing the series of national studies that have given to the form and function of health services research. It further examines the Behavioral Model through 40 years of considerable application and alteration.

Measuring Food Insecurity

2010-02-11
Christopher B. Barrett
Food security is a growing concern worldwide. More than 1 billion people are estimated to lack sufficient dietary energy availability, and at least twice that number suffer micronutrient deficiencies. Because 
 Food security is a growing concern worldwide. More than 1 billion people are estimated to lack sufficient dietary energy availability, and at least twice that number suffer micronutrient deficiencies. Because indicators inform action, much current research focuses on improving food insecurity measurement. Yet estimated prevalence rates and patterns remain tenuous because measuring food security, an elusive concept, remains difficult.

The Risk of Determining Risk with Multivariable Models

1993-02-01
John Concato
Purpose: To review the principles of multivariable analysis and to examine the application of multivariable statistical methods in general medical literature. Data Sources: A computer-assisted search of articles in The 
 Purpose: To review the principles of multivariable analysis and to examine the application of multivariable statistical methods in general medical literature. Data Sources: A computer-assisted search of articles in The Lancet and The New England Journal of Medicine identified 451 publications containing multivariable methods from 1985 through 1989. A random sample of 60 articles that used the two most common methods—logistic regression or proportional hazards analysis—was selected for more intensive review. Data Extraction: During review of the 60 randomly selected articles, the focus was on generally accepted methodologic guidelines that can prevent problems affecting the accuracy and interpretation of multivariable analytic results. Results: From 1985 to 1989, the relative frequency of multivariable statistical methods increased annually from about 10% to 18% among all articles in the two journals. In 44 (73%) of 60 articles using logistic or proportional hazards regression, risk estimates were quantified for individual variables ("risk factors"). Violations and omissions of methodologic guidelines in these 44 articles included overfitting of data; no test of conformity of variables to a linear gradient; no mention of pertinent checks for proportional hazards; no report of testing for interactions between independent variables; and unspecified coding or selection of independent variables. These problems would make the reported results potentially inaccurate, misleading, or difficult to interpret. Conclusions: The findings suggest a need for improvement in the reporting and perhaps conducting of multivariable analyses in medical research.

Food security: definition and measurement

2009-01-20
Per Pinstrup‐Andersen

Actual Causes of Death in the United States

1993-11-10
J. Michael McGinnis
<h3>Objective.</h3> —To identify and quantify the major external (nongenetic) factors that contribute to death in the United States. <h3>Data Sources.</h3> —Articles published between 1977 and 1993 were identified through MEDLINE 
 <h3>Objective.</h3> —To identify and quantify the major external (nongenetic) factors that contribute to death in the United States. <h3>Data Sources.</h3> —Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and compilations of vital statistics and surveillance data were also obtained. <h3>Study Selection.</h3> —Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity. <h3>Data Extraction.</h3> —Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates. <h3>Data Synthesis.</h3> —The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400000 deaths), diet and activity patterns (300 000), alcohol (100 000), microbial agents (90 000), toxic agents (60 000), firearms (35 000), sexual behavior (30 000), motor vehicles (25 000), and illicit use of drugs (20 000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations. <h3>Conclusions.</h3> —Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities. (<i>JAMA</i>. 1993;270:2207-2212)

Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity

2010-07-01
Erin R. Hager , Anna M. Quigg , Maureen M. Black +7 more
OBJECTIVES: To develop a brief screen to identify families at risk for food insecurity (FI) and to evaluate the sensitivity, specificity, and convergent validity of the screen. PATIENTS AND METHODS: 
 OBJECTIVES: To develop a brief screen to identify families at risk for food insecurity (FI) and to evaluate the sensitivity, specificity, and convergent validity of the screen. PATIENTS AND METHODS: Caregivers of children (age: birth through 3 years) from 7 urban medical centers completed the US Department of Agriculture 18-item Household Food Security Survey (HFSS), reports of child health, hospitalizations in their lifetime, and developmental risk. Children were weighed and measured. An FI screen was developed on the basis of affirmative HFSS responses among food-insecure families. Sensitivity and specificity were evaluated. Convergent validity (the correspondence between the FI screen and theoretically related variables) was assessed with logistic regression, adjusted for covariates including study site; the caregivers' race/ethnicity, US-born versus immigrant status, marital status, education, and employment; history of breastfeeding; child's gender; and the child's low birth weight status. RESULTS: The sample included 30 098 families, 23% of which were food insecure. HFSS questions 1 and 2 were most frequently endorsed among food-insecure families (92.5% and 81.9%, respectively). An affirmative response to either question 1 or 2 had a sensitivity of 97% and specificity of 83% and was associated with increased risk of reported poor/fair child health (adjusted odds ratio [aOR]: 1.56; P &amp;lt; .001), hospitalizations in their lifetime (aOR: 1.17; P &amp;lt; .001), and developmental risk (aOR: 1.60; P &amp;lt; .001). CONCLUSIONS: A 2-item FI screen was sensitive, specific, and valid among low-income families with young children. The FI screen rapidly identifies households at risk for FI, enabling providers to target services that ameliorate the health and developmental consequences associated with FI.

Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants

2009-12-25
Hilary K. Seligman , Barbara Laraia , Margot Kushel
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The role of conceptual frameworks in epidemiological analysis: a hierarchical approach.

1997-02-01
CĂ©sar G. Victora , Sharon Huttly , Sandra Cristina Pereira Costa Fuchs +1 more
BACKGROUND: This paper discusses appropriate strategies for multivariate data analysis in epidemiological studies. METHODS: In studies where determinants of disease are sought, it is suggested that the complex hierarchical inter-relationships 
 BACKGROUND: This paper discusses appropriate strategies for multivariate data analysis in epidemiological studies. METHODS: In studies where determinants of disease are sought, it is suggested that the complex hierarchical inter-relationships between these determinants are best managed through the use of conceptual frameworks. Failure to take these aspects into consideration is common in the epidemiological literature and leads to underestimation of the effects of distal determinants. RESULTS: An example of this analytical approach, which is not based purely on statistical associations, is given for assessing determinants of mortality due to diarrhoea in children. CONCLUSIONS: Conceptual frameworks provide guidance for the use of multivariate techniques and aid the interpretation of their results in the light of social and biological knowledge.

Defining equity in health

2003-03-19
Paula Braveman
<b>Study objective:</b> To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept. <b>Design:</b> Conceptual discussion. <b>Setting, 
 <b>Study objective:</b> To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept. <b>Design:</b> Conceptual discussion. <b>Setting, Patients/Participants, and Main results:</b> not applicable. <b>Conclusions:</b> For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health.
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Time-to-Event Analysis of Longitudinal Follow-up of a Survey: Choice of the Time-scale

1997-01-01
Edward L. Korn , Barry I. Graubard , Douglas Midthune
Following individuals sampled in a large-scale health survey for the development of diseases and/or death offers the opportunity to assess the prognostic significance of various risk factors. The proportional hazards 
 Following individuals sampled in a large-scale health survey for the development of diseases and/or death offers the opportunity to assess the prognostic significance of various risk factors. The proportional hazards regression model, which allows for the control of covariates, is frequently used for the analysis of such data. The authors discuss the appropriate time-scale for such regression models, and they recommend that age rather than time since the baseline survey (time-on-study) be used. Additionally, with age as the time-scale, control for calendar-period and/or birth cohort effects can be achieved by stratifying the model on birth cohort. Because, as discussed by the authors, many published analyses have used regression models with time-on-study as the time-scale, it is important to assess the magnitude of the error incurred from this type of incorrect modeling. The authors provide simple conditions for when incorrect use of time-on-study as the time-scale will nevertheless yield approximately unbiased proportional hazards regression coefficients. Examples are given using data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Followup Study. Additional issues concerning the analysis of longitudinal follow-up of survey data are briefly discussed.

Actual Causes of Death in the United States, 2000

2004-03-09
Ali H. Mokdad , James S. Marks , Donna F. Stroup +1 more
ContextModifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention 
 ContextModifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.ObjectivesTo identify and quantify the leading causes of mortality in the United States.DesignComprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality. The search was initially restricted to articles published during or after 1990, but we later included relevant articles published in 1980 to December 31, 2002. Prevalence and relative risk were identified during the literature search. We used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data.Main Outcome MeasuresActual causes of death.ResultsThe leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400 000 deaths; 16.6%), and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000).ConclusionsThese analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.

Social Relationships and Health Behavior Across the Life Course

2010-06-01
Debra Umberson , Robert Crosnoe , Corinne Reczek
Sociological theory and research point to the importance of social relationships in affecting health behavior. This work tends to focus on specific stages of the life course, with a division 
 Sociological theory and research point to the importance of social relationships in affecting health behavior. This work tends to focus on specific stages of the life course, with a division between research on childhood/adolescent and adult populations. Yet recent advances demonstrate that early life course experiences shape health outcomes well into adulthood. We synthesize disparate bodies of research on social ties and health behavior throughout the life course, with attention to explaining how various social ties influence health behaviors at different life stages and how these processes accumulate and reverberate throughout the life course.
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THE CONTRIBUTION OF THE SOCIAL ENVIRONMENT TO HOST RESISTANCE: THE FOURTH WADE HAMPTON FROST LECTURE1

1995-05-01
John C. Cassel
Journal Article THE CONTRIBUTION OF THE SOCIAL ENVIRONMENT TO HOST RESISTANCE: THE FOURTH WADE HAMPTON FROST LECTURE Get access JOHN CASSEL JOHN CASSEL 2Department of Epidemiology, U. of North CarolinaChapel 
 Journal Article THE CONTRIBUTION OF THE SOCIAL ENVIRONMENT TO HOST RESISTANCE: THE FOURTH WADE HAMPTON FROST LECTURE Get access JOHN CASSEL JOHN CASSEL 2Department of Epidemiology, U. of North CarolinaChapel Hill. NC 27514 Search for other works by this author on: Oxford Academic PubMed Google Scholar American Journal of Epidemiology, Volume 141, Issue 9, 1 May 1995, Pages 798–814, https://doi.org/10.1093/oxfordjournals.aje.a117515 Published: 01 May 1995

The Case For More Active Policy Attention To Health Promotion

2002-03-01
J. Michael McGinnis , Pamela Williams‐Russo , James R. Knickman
Until recently, when anthrax triggered a concern about preparedness in the public health infrastructure, U.S. health policy and health spending had been dominated by a focus on payment for medical 
 Until recently, when anthrax triggered a concern about preparedness in the public health infrastructure, U.S. health policy and health spending had been dominated by a focus on payment for medical treatment. The fact that many of the conditions driving the need for treatment are preventable ought to draw attention to policy opportunities for promoting health. Following a brief review of the determinants of population health-genetic predispositions, social circumstances, environmental conditions, behavioral patterns, and medical care-this paper explores some of the factors inhibiting policy attention and resource commitment to the nonmedical determinants of population health and suggests approaches for sharpening the public policy focus to encourage disease prevention and health promotion.

The Social Determinants of Health: It's Time to Consider the Causes of the Causes

2014-01-01
Paula Braveman , Laura M. Gottlieb
During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health (SDH)—the factors apart from medical care that can be influenced 
 During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health (SDH)—the factors apart from medical care that can be influenced by social policies and shape health in powerful ways. We use “medical care” rather than “health care” to refer to clinical services, to avoid potential confusion between “health” and “health care.” The World Health Organization's Commission on the Social Determinants of Health has defined SDH as “the conditions in which people are born, grow, live, work and age” and “the fundamental drivers of these conditions.” The term “social determinants” often evokes factors such as health-related features of neighborhoods (e g., walkability, recreational areas, and accessibility of healthful foods), which can influence health-related behaviors. Evidence has accumulated, however, pointing to socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes This article broadly reviews some of the knowledge accumulated to date that highlights the importance of social—and particularly socioeconomic—factors in shaping health, and plausible pathways and biological mechanisms that may explain their effects. We also discuss challenges to advancing this knowledge and how they might be overcome.
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A SIMPLE METHOD OF ESTIMATING FIFTY PER CENT ENDPOINTS12

1938-05-01
Linda Reed , Hugo Muench
Journal Article A SIMPLE METHOD OF ESTIMATING FIFTY PER CENT ENDPOINTS Get access L.J. REED, L.J. REED Search for other works by this author on: Oxford Academic PubMed Google Scholar 
 Journal Article A SIMPLE METHOD OF ESTIMATING FIFTY PER CENT ENDPOINTS Get access L.J. REED, L.J. REED Search for other works by this author on: Oxford Academic PubMed Google Scholar H. MUENCH H. MUENCH Search for other works by this author on: Oxford Academic PubMed Google Scholar American Journal of Epidemiology, Volume 27, Issue 3, May 1938, Pages 493–497, https://doi.org/10.1093/oxfordjournals.aje.a118408 Published: 01 May 1938 Article history Received: 26 October 1937 Published: 01 May 1938

Food Insecurity And Health Outcomes

2015-11-01
Craig Gundersen , James P. Ziliak
Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of 
 Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.

The Danish Civil Registration System. A cohort of eight million persons.

2006-11-01
Carsten BĂžcker Pedersen , Heine GĂžtzsche , JĂžrgen Ostrup MĂžller +1 more
The Danish Civil Registration System (CRS) was established in 1968, where all persons alive and living in Denmark were registered. Among many other variables, it includes individual information on personal 
 The Danish Civil Registration System (CRS) was established in 1968, where all persons alive and living in Denmark were registered. Among many other variables, it includes individual information on personal identification number, gender, date of birth, place of birth, place of residence, citizenship, continuously updated information on vital status, and the identity of parents and spouses.To evaluate the quality and completeness of the information recorded on persons in the CRS, we considered all persons registered on November 4, 2005, i.e. all persons who were alive and resident in Denmark at least one day from April 2, 1968 to November 4, 2005, or in Greenland from May 1, 1972 to November 4, 2005.A total of 8,176,097 persons were registered. On November 4, 2005, 5,427,687 (66.4%) were alive and resident in Denmark, 56,920 (0.7%) were alive and resident in Greenland, 2,141,373 (26.2%) were dead, 21,160 (0.3%) had disappeared, and 528,957 (6.5%) had emigrated. Among persons born in Denmark 1960 or later the CRS contains complete information on maternal identity. Among persons born in Denmark 1970 or later the CRS contains complete information on paternal identity. Among women born in Denmark April 1935 or later the CRS contains complete information on all their children. Among males born in Denmark April 1945 or later the CRS contains complete information on all their children. The CRS contains complete information on: a) immigrations and emigrations from 1971 onwards, b) permanent residence in a Danish municipality from 1971 onwards, c) permanent residence in a municipality in Greenland from May 1972 onwards, and d) full address in Denmark from 1977 onwards.Data from the CRS is an important research tool in epidemiological research, which enables Danish researchers to carry out representative population-based studies on e.g. the potential clustering of disease and death in families and the potential association between residence and disease and death.

National health and nutrition examination survey: analytic guidelines, 1999-2010.

2013-09-01
Johnson Cl , Ryne Paulose‐Ram , Ogden Cl +4 more
Background-Analytic guide lines were first created in 1996 to assist data users in analyzing data from the Third National Health and Nutrition Examination Survey (NHANES III),conducted from 1988 to 1994 
 Background-Analytic guide lines were first created in 1996 to assist data users in analyzing data from the Third National Health and Nutrition Examination Survey (NHANES III),conducted from 1988 to 1994 by the Centers for Disease Control and Prevention's National Center for Health Statistics. NHANES became a continuous annual survey in 1999, with data released to the public in 2-year intervals. In 2002, 2004, and 2006, guidelines were created and posted on the NHANES website to assist analysts in understanding the key issues related to analyzing data from 1999 onward. This report builds on these previous guidelines and provides the first comprehensive summary of analytic guidelines for the 1999-2010 NHANES data. Objectives-This report provides general guidelines for researchers in analyzing 1999-2010 NHANES publicly released data. Information is presented on key issues related to NHANES data, including sample design, demographic variables, and combining survey cycles. Guidance is also provided on data analysis, including the use of appropriate survey weights, calculating variance estimations, determining the reliability of estimates, age adjustment, and computing population counts.

Kaplan and Sadock's Comprehensive Text Book of Psychiatry

2005-07-01
Daniel Saldanha
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Structural racism and health inequities in the USA: evidence and interventions

2017-04-01
Zinzi Bailey , Nancy Krieger , Madina Agénor +3 more

Journal of the American Statistical Association

1989-01-01
Robert Fildes

Epidemiologic Research: Principles and Quantitative Methods.

1983-09-01
S J Pocock , David G. Kleinbaum , L L Kupper +1 more

Demographic and Health Surveys

2008-08-01
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National health and nutrition examination survey: sample design, 2011-2014.

2014-03-01
Clifford L. Johnson , Sylvia Dohrmann , Vicki Burt +1 more
Background Data collection for the National Health and Nutrition Examination Survey (NHANES) consists of a household screener, an interview, and a physical examination. The screener primarily determines whether any household 
 Background Data collection for the National Health and Nutrition Examination Survey (NHANES) consists of a household screener, an interview, and a physical examination. The screener primarily determines whether any household members are eligible for the interview and examination. Eligibility is established using preset selection probabilities for the desired demographic subdomains. After an eligible sample person is selected, the interview collects person-level demographic, health, and nutrition information, as well as information about the household. The examination includes physical measurements, tests such as hearing and dental examinations, and the collection of blood and urine specimens for laboratory testing. Objectives This report provides some background on the NHANES program, beginning with the first survey cycle in the 1970s and highlighting significant changes since its inception. The report then describes the broad design specifications for the 2011-2014 survey cycle, including survey objectives, domain and precision specifications, and operational requirements unique to NHANES. The report also describes details of the survey design, including the calculation of sampling rates and sample selection methods. Documentation of survey content, data collection procedures, estimation methods, and methods to assess nonsampling errors are reported elsewhere.

Youth Risk Behavior Surveillance<b />United States, 2015

2016-06-09
Laura Kann , Tim McManus , William A. Harris +7 more
Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults. Population-based data on these behaviors at the national, state, and local levels can help 
 Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults. Population-based data on these behaviors at the national, state, and local levels can help monitor the effectiveness of public health interventions designed to protect and promote the health of youth nationwide.September 2014-December 2015.The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma and other priority health behaviors. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results for 118 health behaviors plus obesity, overweight, and asthma from the 2015 national survey, 37 state surveys, and 19 large urban school district surveys conducted among students in grades 9-12.Results from the 2015 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 41.5% of high school students nationwide among the 61.3% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 32.8% had drunk alcohol, and 21.7% had used marijuana. During the 12 months before the survey, 15.5% had been electronically bullied, 20.2% had been bullied on school property, and 8.6% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 41.2% of students had ever had sexual intercourse, 30.1% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 11.5% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 56.9% had used a condom during their last sexual intercourse. Results from the 2015 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. During the 30 days before the survey, 10.8% of high school students had smoked cigarettes and 7.3% had used smokeless tobacco. During the 7 days before the survey, 5.2% of high school students had not eaten fruit or drunk 100% fruit juices and 6.7% had not eaten vegetables. More than one third (41.7%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day and 14.3% had not participated in at least 60 minutes of any kind of physical activity that increased their heart rate and made them breathe hard on at least 1 day during the 7 days before the survey. Further, 13.9% had obesity and 16.0% were overweight.Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most health behaviors varies by sex, race/ethnicity, and grade and across states and large urban school districts. Long-term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased (e.g., riding with a driver who had been drinking alcohol, physical fighting, current cigarette use, current alcohol use, and current sexual activity), but the prevalence of other behaviors and health outcomes has not changed (e.g., suicide attempts treated by a doctor or nurse, smokeless tobacco use, having ever used marijuana, and attending physical education classes) or has increased (e.g., having not gone to school because of safety concerns, obesity, overweight, not eating vegetables, and not drinking milk). Monitoring emerging risk behaviors (e.g., texting and driving, bullying, and electronic vapor product use) is important to understand how they might vary over time.YRBSS data are used widely to compare the prevalence of health behaviors among subpopulations of students; assess trends in health behaviors over time; monitor progress toward achieving 21 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; provide comparable state and large urban school district data; and help develop and evaluate school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth.
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Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide: Version 3

2007-01-01
Jennifer Coates , Anne Swindale , Paula Bilinsky

COVID-19, school closures, and child poverty: a social crisis in the making

2020-04-08
Wim Van Lancker , Zachary Parolin
While coronavirus disease 2019 (COVID-19) continues to spread across the globe, many countries have decided to close schools as part of a physical distancing policy to slow transmission and ease 
 While coronavirus disease 2019 (COVID-19) continues to spread across the globe, many countries have decided to close schools as part of a physical distancing policy to slow transmission and ease the burden on health systems. The UN Educational, Scientific and Cultural Organization estimates that 138 countries have closed schools nationwide, and several other countries have implemented regional or local closures. These school closures are affecting the education of 80% of children worldwide. Although scientific debate is ongoing with regard to the effectiveness of school closures on virus transmission,1Cohen J Kupferschmidt K Countries test tactics in 'war' against COVID-19.Science. 2020; 367: 1287-1288Crossref PubMed Scopus (255) Google Scholar the fact that schools are closed for a long period of time could have detrimental social and health consequences for children living in poverty, and are likely to exacerbate existing inequalities. We discuss two mechanisms through which school closures will affect poor children in the USA and Europe. First, school closures will exacerbate food insecurity. For many students living in poverty, schools are not only a place for learning but also for eating healthily. Research shows that school lunch is associated with improvements in academic performance, whereas food insecurity (including irregular or unhealthy diets) is associated with low educational attainment and substantial risks to the physical health and mental wellbeing of children.2Schwartz AE Rothbart MW Let them eat lunch: the impact of universal free meals on student performance.J Policy Anal Manage. 2019; (published online Oct 10.)DOI:10.1002/pam.22175Crossref Scopus (77) Google Scholar, 3Bitler MP Seifoddini A Health impacts of food assistance: evidence from the United States.Annu Rev Resour Economics. 2019; 11: 261-287Crossref Scopus (26) Google Scholar The number of children facing food insecurity is substantial. According to Eurostat, 6·6% of households with children in the European Union—5·5% in the UK—cannot afford a meal with meat, fish, or a vegetarian equivalent every second day. Comparable estimates in the USA suggest that 14% of households with children had food insecurity in 2018.4United States Department of AgricultureFood security in the United States.https://www.ers.usda.gov/data-products/food-security-in-the-united-states/Date accessed: March 25, 2020Google Scholar Second, research suggests that non-school factors are a primary source of inequalities in educational outcomes. The gap in mathematical and literacy skills between children from lower and higher socioeconomic backgrounds often widens during school holiday periods.5Alexander KL Entwisle DR Olson LS Lasting consequences of the summer learning gap.Am Sociol Rev. 2007; 72: 167-180Crossref Scopus (414) Google Scholar The summer holiday in most American schools is estimated to contribute to a loss in academic achievement equivalent to one month of education for children with low socioeconomic status; however, this effect is not observed for children with higher socioeconomic status.6Cooper H Nye B Charlton K Lindsay J Greathouse S The effects of summer vacation on achievement test scores: a narrative and meta-analytic review.Rev Educ Res. 1996; 66: 227-268Crossref Scopus (538) Google Scholar Summer holidays are also associated with a setback in mental health and wellbeing for children and adolescents.7Morgan K Melendez-Torres GJ Bond A et al.Socio-economic inequalities in adolescent summer holiday experiences, and mental wellbeing on return to school: analysis of the school health research network/health behaviour in school-aged children survey in Wales.Int J Environ Res Public Health. 2019; 161107Crossref Scopus (31) Google Scholar Although the current school closures differ from summer holidays in that learning is expected to continue digitally, the closures are likely to widen the learning gap between children from lower-income and higher-income families. Children from low-income households live in conditions that make home schooling difficult. Online learning environments usually require computers and a reliable internet connection. In Europe, a substantial number of children live in homes in which they have no suitable place to do homework (5%) or have no access to the internet (6·9%). Furthermore, 10·2% of children live in homes that cannot be heated adequately, 7·2% have no access to outdoor leisure facilities, and 5% do not have access to books at the appropriate reading level.8Guio AC Gordon D Marlier E Najera H Pomati M Towards an EU measure of child deprivation.Child Indic Res. 2018; 11: 835-860Crossref PubMed Scopus (55) Google Scholar In the USA, an estimated 2·5% of students in public schools do not live in a stable residence. In New York city, where a large proportion of COVID-19 cases in the USA have been observed, one in ten students were homeless or experienced severe housing instability during the previous school year.9National Center for Homeless EducationFederal Data Summary. School Year 2015–16 through 2017–18.https://nche.ed.gov/wp-content/uploads/2020/01/Federal-Data-Summary-SY-15.16-to-17.18-Published-1.30.2020.pdfDate: 2020Date accessed: April 3, 2020Google Scholar While learning might continue unimpeded for children from higher income households, children from lower income households are likely to struggle to complete homework and online courses because of their precarious housing situations. Beyond the educational challenges, however, low-income families face an additional threat: the ongoing pandemic is expected to lead to a severe economic recession. Previous recessions have exacerbated levels of child poverty with long-lasting consequences for children's health, wellbeing, and learning outcomes.10Cantillon B Chzhen Y Handa S Nolan B Children of austerity. Impact of the great recession on child poverty in rich countries. UNICEF, Oxford University Press, New York2017https://www.unicef-irc.org/publications/pdf/Children_of_austerity.pdfDate accessed: April 3, 2020Google Scholar Policy makers, school administrators, and other local officials thus face two challenges. First, the immediate nutrition and learning needs of poor students must continue to be addressed. The continuation of school-provided meals is essential in preventing widespread food insecurity. Teachers should also consider how to adapt their learning materials for students without access to wireless internet, a computer, or a place to study. Second, local and national legislators must prepare for the considerable challenges that await when the pandemic subsides. At the local level, an adequate response must include targeted education and material support for children from low-income households to begin to close the learning gap that is likely to have occurred. From a policy perspective, legislators should consider providing regular income support for households with children during the impending economic crisis to prevent a deepening and broadening of child poverty. Without such action, the current health crisis could become a social crisis that will have long-lasting consequences for children in low-income families. We declare no competing interests. COVID-19 puts societies to the test
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The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States

2020-06-16
Don Bambino Geno Tai , Aditya Shah , Chyke A. Doubeni +2 more
Abstract The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. Although the 
 Abstract The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. Although the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.
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Social Determinants of Health and Diabetes: A Scientific Review

2020-11-02
Felicia Hill‐Briggs , Nancy E. Adler , Seth A. Berkowitz +5 more
Decades of research have demonstrated that diabetes affects racial and ethnic minority and low-income adult populations in the U.S. disproportionately, with relatively intractable patterns seen in these populations’ higher risk 
 Decades of research have demonstrated that diabetes affects racial and ethnic minority and low-income adult populations in the U.S. disproportionately, with relatively intractable patterns seen in these populations’ higher risk of diabetes and rates of diabetes complications and mortality (1). With a health care shift toward greater emphasis on population health outcomes and value-based care, social determinants of health (SDOH) have risen to the forefront as essential intervention targets to achieve health equity (2–4). Most recently, the COVID-19 pandemic has highlighted unequal vulnerabilities borne by racial and ethnic minority groups and by disadvantaged communities. In the wake of concurrent pandemic and racial injustice events in the U.S., the American College of Physicians, American Academy of Pediatrics, Society of General Internal Medicine, National Academy of Medicine, and other professional organizations have published statements on SDOH (5–8), and calls to action focus on amelioration of these determinants at individual, organizational, and policy levels (9–11). In diabetes, understanding and mitigating the impact of SDOH are priorities due to disease prevalence, economic costs, and disproportionate population burden (12–14). In 2013, the American Diabetes Association (ADA) published a scientific statement on socioecological determinants of prediabetes and type 2 diabetes (15). Toward the goal ofunderstanding and advancing opportunities for health improvement among the population with diabetes through addressing SDOH, ADA convened the current SDOH and diabetes writing committee, prepandemic, to review the literature on 1 ) associations of SDOH with diabetes risk and outcomes and 2 ) impact of interventions targeting amelioration of SDOH on diabetes outcomes. This article begins with an overview of key definitions and SDOH frameworks. The literature review focuses primarily on U.S.-based studies of adults with diabetes and on five SDOH: socioeconomic status (education, income, occupation); neighborhood and physical environment (housing, built environment, toxic environmental 


THE CONTRIBUTION OF THE SOCIAL ENVIRONMENT TO HOST RESISTANCE1

1976-08-01
John C. Cassel
Journal Article THE CONTRIBUTION OF THE SOCIAL ENVIRONMENT TO HOST RESISTANCE: THE FOURTH WADE HAMPTON FROST LECTURE Get access JOHN CASSEL JOHN CASSEL 2Department of Epidemiology, U. of North CarolinaChapel 
 Journal Article THE CONTRIBUTION OF THE SOCIAL ENVIRONMENT TO HOST RESISTANCE: THE FOURTH WADE HAMPTON FROST LECTURE Get access JOHN CASSEL JOHN CASSEL 2Department of Epidemiology, U. of North CarolinaChapel Hill, NC 27514 Search for other works by this author on: Oxford Academic PubMed Google Scholar American Journal of Epidemiology, Volume 104, Issue 2, August 1976, Pages 107–123, https://doi.org/10.1093/oxfordjournals.aje.a112281 Published: 01 August 1976

Risk Behavior in Adolescence: A Psychosocial Framework for Understanding and Action

2021-11-09
Richard Jessor
The exploration begins with some considerations about the basic notion of risk itself; it then turns to an examination of the organization of adolescent risk behavior and the utility of 
 The exploration begins with some considerations about the basic notion of risk itself; it then turns to an examination of the organization of adolescent risk behavior and the utility of the concept of life-style. In the tradition of epidemiology, the use of the concept of risk has been essentially biomedical, reflecting a concern for adverse outcomes related to morbidity and mortality. The epidemiological search has been to locate agents or conditions that are associated with an increased probability of outcomes that compromise health, the quality of life, or life itself. The evidence for covariation has been less strong where nonproblem, health-risk behaviors are involved, such as eating, exercise, and safety behaviors. The effort to conceptualize and elaborate the antecedents or determinants of risk behaviors, as established risk factors, can continue to make use of the orientation of epidemiology toward the identification of risk factors.

Handbook of Research Methods in Health Social Sciences

2019-01-01
Pranee Liamputtong

THE IMPACT OF CONFOUNDER SELECTION CRITERIA ON EFFECT ESTIMATION

1989-01-01
RUTH M. MICKEY , Sander Greenland
Journal Article THE IMPACT OF CONFOUNDER SELECTION CRITERIA ON EFFECT ESTIMATION Get access RUTH M. MICKEY, RUTH M. MICKEY 1Department of Mathematics and Statistics, University of VermontBurlington, VT 05405 Reprint 
 Journal Article THE IMPACT OF CONFOUNDER SELECTION CRITERIA ON EFFECT ESTIMATION Get access RUTH M. MICKEY, RUTH M. MICKEY 1Department of Mathematics and Statistics, University of VermontBurlington, VT 05405 Reprint requests to Dr. Ruth M. Mickey. Search for other works by this author on: Oxford Academic PubMed Google Scholar SANDER GREENLAND SANDER GREENLAND 2Department of Epidemiology, School of Public Health, University of CaliforniaLos Angeles, CA 90024 Search for other works by this author on: Oxford Academic PubMed Google Scholar American Journal of Epidemiology, Volume 129, Issue 1, January 1989, Pages 125–137, https://doi.org/10.1093/oxfordjournals.aje.a115101 Published: 01 January 1989 Article history Received: 05 July 1988 Published: 01 January 1989

Establishing national food priority in Saudi Arabia: developing a priority matrix for food

2025-06-26
Ghadir A. Fallata , Omar Alhumaidan , Haya Alomran +2 more | Agriculture & Food Security

Cooking skills and food insecurity

2025-06-25
Diego Monteza‐Quiroz , AndrĂ©s Silva , MarĂ­a Isabel Sactic | PLoS ONE
Cooking skills play a relevant role in food security, which encompasses the availability, accessibility, utilization, and stability of food. While previous discussions have mainly focused on accessibility, particularly economic access 
 Cooking skills play a relevant role in food security, which encompasses the availability, accessibility, utilization, and stability of food. While previous discussions have mainly focused on accessibility, particularly economic access through food prices and income, this article explores the dimension of food utilization by analyzing the relation between food insecurity and cooking-related variables. We conducted a survey of 106 low-income households in an urban area of Santiago, Chile. Food insecurity was measured using the Food Insecurity Experience Scale (FIES) developed by the FAO. Using principal component analysis, we constructed two indexes reflecting subjective perceptions of cooking skills. We then applied probit models to examine how both subjective and objective cooking skills variables are associated with the probability of experiencing food insecurity. Results show that individuals who can prepare six to ten egg preparations have an 8.4 percentage point lower prevalence of experiencing food insecurity, while those who can prepare more than ten such preparations show a 30.5 percentage point lower prevalence compared to those who can prepare five or fewer. Moreover, our results found a positive prevalence between negative subjective perceptions and food insecurity of 8.8 percentage point. For the first time, this study jointly examines subjective perceptions and self-reported objective measures of cooking skills in relation to food insecurity. We hope this work contributes to expanding the food insecurity discussion beyond economic access and supports the design of food security policies focused on improving cooking aspects.

Health-Related Social Needs and Total Healthcare Cost: A Cross-Sectional Study in a Large Integrated Health System

2025-06-25
Ariel Silverman , Paul J. Chung , Michael K. Gould +5 more | Journal of General Internal Medicine

Community Engagement: A Foundation for Health Equity and Resilience

2025-06-25
J. Lloyd Michener , Asia Williams , Debra Oto-Kent +1 more | American Journal of Public Health

Nonresponse to Health-Related Social Needs Screening Items Within Pediatric Primary Care

2025-06-25
Maya I. Ragavan , Kelsey Schweiberger , Deepak Palakshappa +3 more | PEDIATRICS
BACKGROUND AND OBJECTIVES Health-related social needs (HRSN) screening has become standard in pediatric health care. HRSN screening may connect families with resources; however, the rates at which families decline screening 
 BACKGROUND AND OBJECTIVES Health-related social needs (HRSN) screening has become standard in pediatric health care. HRSN screening may connect families with resources; however, the rates at which families decline screening in pediatric primary care may limit the impact of screening. We aimed to quantify the frequency of nonresponse to HRSN items and assess patient characteristics associated with nonresponse. METHODS We completed a cross-sectional analysis of electronic health record data of an 8-item HRSN questionnaire from 54 pediatric practices. Participants were categorized as nonresponse if they marked “decline” or skipped an HRSN item. We examined nonresponse to each item and examined factors associated with nonresponse to 1 or more items through multilevel logistic regression models with practice-level random effects. RESULTS Caregivers of 177 094 children receiving an HRSN questionnaire between 2021 and 2024 were included; nonresponse to 1 or more HRSN items occurred for 9.6% of caregivers. In adjusted analyses, nonresponse was higher for questionnaires of children with public insurance (13.7%; 95% CI, 13.3–14.1) compared with those of commercially insured children (6.7%; 95% CI, 6.4%–6.9%). Similarly, nonresponse was higher for children identified as non-Hispanic Black (11.8%; 95% CI, 11.3%–12.3%), Hispanic (13.3%; 95% CI, 12.1%–14.5%), or another non-white, non-Black, and non-Hispanic race and ethnicity (17.0%; 95% CI, 16.0%–17.9%), compared with non-Hispanic white children (8.4%; 95% CI, 8.1%–8.6%). CONCLUSIONS Study results suggest overall high completion of HRSN screening but higher nonresponse rates for those within sociodemographic groups that may have higher unmet HRSN. Developing HRSN interventions with families that are adaptive to family and neighborhood contexts may improve trustworthiness of screening and increase resource connection.

Correction to “Effects of Social Vulnerability and Environmental Burden on Care Fragmentation and Social Needs Among Individuals with Rheumatic Conditions”

2025-06-25
| Arthritis Care & Research

The problem with food security assessments and a case for food sovereignty evaluative tools: comparing food security and food sovereignty assessments in Haiti

2025-06-24
Marylynn Steckley , Joshua Steckley , Walner Osna +2 more | Agroecology and Sustainable Food Systems

Association of Food Insecurity and Short-Term Kidney Outcomes in Neonates

2025-06-24
Michelle C. Starr , Ana Maria Trindade Grégio , Paulomi Chaudhry +3 more | American Journal of Perinatology
Abstract This study aimed to determine the association between food insecurity (FI) and short-term kidney outcomes in neonates. Single-site prospective cohort study of sequentially admitted neonates to two neonatal intensive 
 Abstract This study aimed to determine the association between food insecurity (FI) and short-term kidney outcomes in neonates. Single-site prospective cohort study of sequentially admitted neonates to two neonatal intensive care units (NICUs). We collected demographic characteristics and FI status on maternal–neonatal dyads using the Hunger Vital Signs tool. Kidney outcomes (acute kidney injury [AKI]) within the first 14 days, recovery from AKI, and serum creatinine (SCr) at day 14 of age) were compared by FI status. Of the 70 neonates in this study, 39% lived in FI households. Infants from FI households were more likely to have early AKI (56 vs. 14%, p = 0.002) and were more likely to have a slower recovery from AKI (66 vs. 17%, p = 0.035) than those from food-secure households. Neonates from FI households were also more likely to have an abnormally elevated SCr at 2 weeks of age (66 vs. 17%, p = 0.007). FI is common in families with neonates admitted to the NICU. Neonates born into FI households were more likely to have early AKI, slower AKI recovery, and elevated SCr at 2 weeks of age. Our findings emphasize the importance of FI screening and recognition as part of prenatal care and as an essential social determinant of health in studies investigating kidney outcomes.

Factors associated with hepatitis B mother-to-child transmission in a national prevention program

2025-06-24
Moran Ki , Byung‐Woo Kim , Dahye Baik +1 more | Clinical and Molecular Hepatology
Hepatitis B virus (HBV) mother-to-child transmission (MTCT) remains a global health concern, with over 90% of perinatal infections leading to chronic HBV. To evaluate long-term trends in MTCT rates and 
 Hepatitis B virus (HBV) mother-to-child transmission (MTCT) remains a global health concern, with over 90% of perinatal infections leading to chronic HBV. To evaluate long-term trends in MTCT rates and associated factors within Korea's national program. Population-based cohort study using linked data from the Perinatal Hepatitis B Prevention Program (PHBPP) and National Health Insurance Services in Korea. The study included HBsAg-positive mother-infant pairs with post-vaccination serologic results from 2002 to 2021. Among the 154,478 mother-infant pairs, the overall MTCT rate after prophylaxis was 2.3%. Antiviral use lowered MTCT rates (0.9% vs 2.4%) particularly in HBeAg-positivity (1.0% vs 5.9%; aOR, 0.21; 95% CI, 0.14-0.32). Lower MTCT rates were observed for cesarean-section vs vaginal delivery (1.9% vs 2.6%; aOR, 0.78; 95% CI, 0.73-0.84) and breastfeeding vs formula feeding (1.8% vs 2.8%; aOR, 0.65; 95% CI, 0.56-0.76). Annual MTCT rates decreased from 3.6% (2002-2005) to 1.3% (2018-2021). Antivirals reduced MTCT rates; initiation at 14-27 weeks (0.39%), or 28-32 weeks (0.44%) vs ≄33 weeks (1.47%); postpartum continuation (0.55%) vs antepartum discontinuation (1.44%); use ≄61 days (0.51%) vs 1-60 days (1.67%). Lower MTCT risk was associated with maternal (old age, high income) and infant (female sex, pre-term birth) factors. This comprehensive analysis of the PHBPP in Korea demonstrates that the use of antivirals, breastfeeding, and cesarean section, combined with conventional immunoprophylaxis, has significantly reduced MTCT rates. These results are crucial for global HBV elimination and can help to guide HBV MTCT prevention strategies.

Of Beef and Public Confusion, Take I: Nutrition

2025-06-24
| The MIT Press eBooks

Food Insecurity in Relation to Sustainable and Healthy Eating Behaviors and Obesity in TĂŒrkiye

2025-06-24
Gökçe Ünal | Online TĂŒrk Sağlık Bilimleri Dergisi
Objective: This study aims to determine food insecurity (FI) in relation to sustainable and healthy eating behaviors and obesity in TĂŒrkiye. Materials and Methods: The study was conducted between March 
 Objective: This study aims to determine food insecurity (FI) in relation to sustainable and healthy eating behaviors and obesity in TĂŒrkiye. Materials and Methods: The study was conducted between March and May 2023 in Samsun, TĂŒrkiye and included 461 people (67.0% women; aged 19 years and over). Data were collected via the online survey method. Using self-reported body weight (kg) and height (m), obesity was determined based on BMI ≄30 kg/m2. The Food Insecurity Experience Scale (FIES) and Sustainable and Healthy Eating Behaviors Scale (SHEBS) were administered. Results: The rate of FI was 42.5% and was higher in individuals aged 19–34 years (50.9%) than in individuals aged 35–49 years (36.4%) and 65+ years (34.0%) (p=0.03). FI was associated with a lower risk of obesity in the unadjusted model (p=0.005). After adjusting for gender, age, marital status and education degree, FI was no longer significantly associated with obesity (p=0.07) and was not associated with SHEBS score (p=0.61). Conclusions: This study suggests that FI is not related to sustainable and healthy eating behaviors and obesity in this population. More studies investigating FI at the individual level in larger populations in TĂŒrkiye and the environmental and health impacts of FI are needed.

Household cooking frequency and diet quality are mediated by food shopping behaviors among U.S. African-American adults: A NHANES analysis

2025-06-24
Nicole Farmer , Narjis Kazmi , Kristina Franklin +3 more | PLoS ONE
Among U.S. adults who self-identified as African-American, frequent household cooking is related to better dietary quality and adherence to U.S. dietary guidelines, as measured by the Healthy Eating Index. However, 
 Among U.S. adults who self-identified as African-American, frequent household cooking is related to better dietary quality and adherence to U.S. dietary guidelines, as measured by the Healthy Eating Index. However, African-Americans often reside in commercially disinvested areas with limited access to major food retailers. This study examined whether food shopping behaviors—travel time to grocery store and frequency of major food shopping—affect the relationship between cooking frequency and diet quality, potentially influencing community nutrition education outcomes. Using data from 2,434 non-Hispanic Black adults (≄ 18 years) from the 2007–2010 NHANES cycles, we performed linear regression analysis with Complex Sample General Linear Models (CSGLM). The Healthy Eating Index 2010 measured daily and dinner dietary quality. Mediation analysis was conducted to evaluate if food shopping behaviors are involved in potential causal pathways. Results showed that major food shopping frequency, but not travel time to a grocery store, was significantly associated with daily diet quality and cooking frequency (p &lt; 0.001). Mediation analysis revealed that food shopping frequency significantly mediated the relationship between cooking frequency and dinner quality (52.44% mediating effect). When stratified by food security status, shopping frequency was only a significant mediator of cooking frequency and diet quality for those with full or marginal food security (64.89% mediating effect). For food-insecure individuals, major food shopping did not mediate the cooking-diet quality relationship. These findings suggest that food shopping frequency is a critical factor when assessing the link between cooking frequency and diet quality, and may inform factors to optimize food shopping behaviors within community nutrition education programs among those experiencing food-insecurity in the U.S.

Food security

2025-06-23
Patrick Hough | Routledge eBooks

Food Security and Sustainable Developmental Goals:Relationships and Implications for Attainment

2025-06-23
Isaac Oluwadamilare Oni , Oluwabunmi Bola Olajide , Damilola Olajide | International Journal of Health
Food security is a phenomenon that is of global public health interest. It is also integral ‎to the attainment of the 2030 target for the 17 Sustainable Development Goals (SDGs). 
 Food security is a phenomenon that is of global public health interest. It is also integral ‎to the attainment of the 2030 target for the 17 Sustainable Development Goals (SDGs). ‎Food is a basic necessity of life and central to human existence. Food security is ‎relevant to the gross productivity at both the individual and national levels. The objectives of this review are to establish the connection between food security and 17 ‎SDGs, challenges to secured food systems as well as global trend for ‎food insecurity. A search for relevant articles published until November 2024 from ‎popular repositories was conducted. The key terms used for the search included words ‎and/or phrases related to food security, sustainable development goals, food insecurity‎, and challenges of food security. This review presents an overview of the continuous ‎increase in the rate of food insecurity, the challenges limiting the actualization of food ‎security, and the sheer connection between food security and other SDGs, as well as the ‎implications for the attainment of other SDGs. Due to the existing network between food ‎security and these SDGs, the application of one health concept would be crucial ‎to overcoming several challenges in public health. Multi-sector collaboration and ‎partnership would be important in reducing food insecurity to the barest minimum‎.

The Intersection of Disability, Race, Ethnicity, and Financial Background on Food Insecurity Among Medical Students

2025-06-23
Mytien Nguyen , Bassel M. Shanab , Pavan Khosla +7 more | Academic Medicine
Food insecurity is negatively associated with college students' well-being and academic performance. Little is known about the prevalence of food insecurity among medical students. This study examined variations in food 
 Food insecurity is negatively associated with college students' well-being and academic performance. Little is known about the prevalence of food insecurity among medical students. This study examined variations in food insecurity among medical students at 15 schools, analyzing differences by disability status, race, ethnicity, and financial background. Between March-October 2024, 1,659 students across 15 MD-granting medical schools completed an online survey. Over the past 12 months, food insecurity was assessed using the 10-item U.S. Household Food Security Survey Module. Additional survey measures included age, gender identity, race, ethnicity, Pell Grant recipient status, disability status, and graduation year. Poisson regression models were utilized to estimate the relative risk of food insecurity based on self-reported disability, race, ethnicity, and financial background and their intersections. In the analytic sample, a higher proportion of students with disability (33.7% vs 21.8%, P < .001), from low-income backgrounds (34.9% vs 20.3%, P < .001), and those underrepresented in medicine (URiM) reported food insecurity (37.6% vs 19.7%, P < .001). Across intersectional groups, URiM low-income students with disability have the highest rate of food insecurity (62.5% vs 16.8% for nondisabled non-URiM non-low-income peers, P < .001). In the fully adjusted model, compared to nondisabled non-URiM non-low-income students, non-URiM and URiM low-income students with disability (non-URiM aRR: 2.44, 95% CI 1.72-3.48; URiM aRR: 3.52, 95% CI 2.79-4.45) had a higher relative risk of food insecurity. In this study, nearly 1 in 4 medical students were food insecure. URiM, low-income, and students with disabilities reported food insecurity at a significantly higher rate than their peers, with over half of URiM low-income students with disabilities reporting food insecurity. These findings suggest a promising yet underutilized avenue for approaches to enhancing well-being. Proactive efforts should prioritize supporting marginalized students by linking them to nutrition resources and advocating for policies that address their essential needs.

Mapping the research landscape of food insecurity among tertiary education students worldwide (2002–2023): a scopus database analysis

2025-06-23
Olutosin Ademola Otekunrin , Oluwaseun A. Otekunrin | Discover Sustainability

Food Availability in Homes with Children and Adolescents: Associated Factors During the COVID-19 Pandemic

2025-06-23
Priscila Pena Camargo , Érica Costa Rodrigues , Mariana Carvalho de Menezes +3 more | Journal of food security

Educational attainment of children with major congenital anomalies during primary school in England: a population cohort study using linked administrative data from ECHILD

2025-06-22
Joachim Tan , A J Cant , Kate Marie Lewis +7 more | medRxiv (Cold Spring Harbor Laboratory)
Background Major congenital anomalies (CAs) occur in 2.3% of livebirths and are associated with lower educational attainment in affected children. Understanding how attainment changes throughout primary school would inform parents, 
 Background Major congenital anomalies (CAs) occur in 2.3% of livebirths and are associated with lower educational attainment in affected children. Understanding how attainment changes throughout primary school would inform parents, schools and organisations and help plan support. Objectives We compared school enrolment and attainment at ages 5, 7 and 11 in children with different CAs and their peers in England using linked administrative hospital and education data in the ECHILD database. Methods We included all singleton children born in NHS-funded hospitals from September 2003 to August 2008 who enrolled in state-funded schools at age 4-5. CAs were identified from hospital diagnoses, procedures or death records. We described school enrolment, school-readiness, the percentages of children who sat curriculum assessments and who achieved expected levels in English and Maths at three ages. We estimated risk ratios of children with CAs achieving expected levels compared with peers, adjusting for sociodemographic factors. Results Of 2,351,589 singleton children enrolled at age 5, 78,847 (3.5%) had CAs. At age 11, 88.7% of enrolled children with CAs sat assessments versus 97.2% of peers. Proportionally fewer children with CAs (45.7%) were school-ready at age 5 versus peers (57.0%). For English, 56.9%, 55.4% and 65.3% of children with CAs achieved expected levels at ages 5, 7 and 11 respectively, consistently 11%-12% fewer than peers; similar gaps persisted for Maths. Children with CAs were on average less likely than peers to achieve expected levels [adjusted risk ratio, aRR (95%CI): 0.86 (0.85,0.86)] but this varied substantially across CA subgroups [aRR (95%CI) range: 0.01 (0.01,0.02) to 1.04 (0.96,1.12)]. Conclusion The attainment gap between children with CAs and peers remained unchanged across subjects and ages, with proportionally fewer sitting assessments at age 11. Better monitoring and support for these children from school entry could help optimise learning experiences and fulfil their academic potential.

Assessing Households’ Food Insecurity and Coping Strategies in Seme, Nigeria: A Borderland Community in Economic Transition

2025-06-21
Abraham Falola , A.S. Olanrewaju , Ridwan Mukaila +2 more | Journal of Hunger & Environmental Nutrition

Brecha de cobertura universal de salud en la reducciĂłn de la inseguridad alimentaria infantil en Ecuador

2025-06-20
Flor Elizabeth Dueñas Espinoza , Ariana Moriela Aristega Villalva , Jenny Maribel Acosta Zagal +2 more | LATAM Revista Latinoamericana de Ciencias Sociales y Humanidades
El estudio explorĂł la evidencia disponible sobre la brecha de cobertura universal de salud en la reducciĂłn de la inseguridad alimentaria infantil en Ecuador durante el periodo 2021 a 2025. 
 El estudio explorĂł la evidencia disponible sobre la brecha de cobertura universal de salud en la reducciĂłn de la inseguridad alimentaria infantil en Ecuador durante el periodo 2021 a 2025. Se ejecutĂł una revisiĂłn bibliogrĂĄfica estructurada en MDPI, PubMed, Scielo, ScienceDirect, Latindex y Dialnet, se aplicaron operadores AND/OR para combinar “cobertura sanitaria universal”, “inseguridad alimentaria infantil”, “desnutriciĂłn crĂłnica”, “malnutriciĂłn”, “Ecuador”, “niños” y “adolescentes”; se incluyeron investigaciones cuantitativas, cualitativas, mixtas y revisiones sistemĂĄticas de los Ășltimos 5 años. El examen de los datos mostrĂł un crecimiento sostenido de la atenciĂłn primaria y una mejora en el acceso temprano a servicios preventivos; con todo, la desnutriciĂłn crĂłnica siguiĂł marcada por brechas territoriales y socioeconĂłmicas. La protecciĂłn financiera incompleta, la ausencia de nutricionistas en el primer nivel y la escasa articulaciĂłn con circuitos alimentarios locales atenuaron la repercusiĂłn de la cobertura sobre la seguridad nutricional. De forma convergente, la coordinaciĂłn intersectorial sĂłlida y la implicaciĂłn comunitaria se vincularon con descensos de malnutriciĂłn, mientras jurisdicciones con gobernanza dispersa exhibieron avances moderados. En conclusiĂłn, los hallazgos amplĂ­an el conocimiento sobre la dinĂĄmica cobertura-nutriciĂłn al demostrar que la accesibilidad operativa, la articulaciĂłn sectorial y la corresponsabilidad familiar constituyen ejes interdependientes para reducir la inseguridad alimentaria infantil; ademĂĄs, proporcionan una base empĂ­rica que puede guiar la planificaciĂłn pĂșblica, el diseño de presupuestos compartidos y la vigilancia comunitaria de la nutriciĂłn infantil.

Fostering food security boosts student success

2025-06-20
Claudine McCarthy | Student Affairs Today
NASHVILLE, Tenn. — When Robin DeMott, Chief External Affairs Officer, Eastern New Mexico University ‐ Ruidoso, learned that 77% of their students had basic needs insecurity, 68% had very low 
 NASHVILLE, Tenn. — When Robin DeMott, Chief External Affairs Officer, Eastern New Mexico University ‐ Ruidoso, learned that 77% of their students had basic needs insecurity, 68% had very low food insecurity, and 40% experienced homelessness in the past year, she took action. Recognizing the correlation between student success and food/housing security, DeMott used a $235,000 grant to meet students’ basic needs.

The Interplay Between Summer Meals, Food Insecurity, and Diet Quality Among Low-Income Children in Maryland, USA: A Multiphase Cross-Sectional Study

2025-06-20
Yuyi Chen , Erin R. Hager , Julia Groß +1 more | Nutrients
Background: Food insecurity and poor diet quality disproportionately affect U.S. children from low-income households, with summer school closures exacerbating risks. Federally funded programs like the Summer Food Service Program (SFSP) 
 Background: Food insecurity and poor diet quality disproportionately affect U.S. children from low-income households, with summer school closures exacerbating risks. Federally funded programs like the Summer Food Service Program (SFSP) and SUN Bucks (Summer EBT) aim to address these challenges, yet evidence of their post-pandemic dietary impact remains limited. Objectives: This study examines the relationship between policy innovations, summer meal participation, food insecurity, and diet quality among children from low-income households in Prince George’s County, Maryland. Methods: A cross-sectional design analyzed data from 158 households in Prince George’s County Public Schools across two waves (early fall 2022 and 2023). Validated tools (USDA’s Six-Item Short Form and Dietary Screener Questionnaire) assessed food security and diet quality. Sociodemographic factors, program participation, and dietary deviations from the 2020–2025 Dietary Guidelines were analyzed. Multivariate logistic regression identified determinants of poor diet quality (≄2 guideline deviations), adjusting for ethnicity, age, and housing stability. Results: Only 32.28% of eligible households participated in summer meal programs, with non-participation driven by lack of awareness (53.68%) and transportation barriers (11.58%). Significant dietary gaps included inadequate whole grain intake (0.8 vs. 3.0 servings/day) and excessive added sugars (14% of daily calories). Summer meal participation was associated with reduced odds of poor diet quality (OR = 0.23, p = 0.030), while older age (OR = 52.97, p &lt; 0.001) and very low food security (OR = 8.42, p = 0.036) increased risk. Hispanic ethnicity had lower odds (OR = 0.17, p = 0.019) despite higher baseline food insecurity. Conclusions: Summer meal participation was associated with improved dietary outcomes but faced systemic participation barriers. Findings support policy reforms, such as multilingual outreach and mobile meal distribution, to address identified gaps.

Are Remitters at Risk for Lower Food Security and Dietary Quality? An Exploratory Study of Mexican Immigrants in NYC

2025-06-20
Daniela Cruz-Salazar , Neil Hwang , Shirshendu Chatterjee +2 more | Community Health Equity Research & Policy
Objective To examine whether remitting behavior among Mexican immigrants in the Bronx is associated with increased food insecurity and lower dietary quality, with a particular focus on potential gender differences 
 Objective To examine whether remitting behavior among Mexican immigrants in the Bronx is associated with increased food insecurity and lower dietary quality, with a particular focus on potential gender differences in these associations. Design Descriptive and bivariate statistics are shown, and binary logistic multivariate regression models are computed. Setting Data come from a study exploring the social networks, dietary behaviors and outcomes of Mexican immigrants recruited from a Catholic Church in the Bronx between January 2019 and June 2019. Participants 81 Mexican immigrants 18 years or older living in the Bronx, New York City. Results A statistically significant ( p &lt; .1) relationship was not found between sending remittances and food insecurity; however, we found that women remitters had higher odds than men remitters of having low dietary quality ( p &lt; .060). We also found that a higher Body Mass Index was associated with higher odds of experiencing low and very low food security ( p &lt; .037). Conclusions Further research with nationally representative data is needed to investigate the full extent of the association between remittances and nutritional outcomes of remitters.

Chronic Disease and Risk Factor Prevalence in Multiracial Subgroups: California, 2014-2023

2025-06-20
Tracy Lam-Hine , Michelle C. Odden , Aliya Saperstein +2 more | medRxiv (Cold Spring Harbor Laboratory)
Multiracial adults represent a growing U.S. population but are often grouped together or reassigned to single-race categories in public health data. Aggregation can obscure important variation across subgroups, limiting opportunities 
 Multiracial adults represent a growing U.S. population but are often grouped together or reassigned to single-race categories in public health data. Aggregation can obscure important variation across subgroups, limiting opportunities for targeted prevention. We analyzed 2014-2023 California Behavioral Risk Factor Surveillance System data (n=100,177) to estimate prevalence of 28 health indicators across racial and ethnic groups, including disaggregated Multiracial subgroups. We categorized participants based on all self-identified races and aggregated subgroups with N<50. We standardized prevalence by age and sex using 2020 California census data, calculated relative standard errors, and used survey-weighted methods to compare prevalence and subgroup differences. Among 100,177 participants, Multiracial subgroups had the highest prevalence for 24 of 28 outcomes. American Indian or Alaska Native-Black and Hispanic-Black-White adults had the highest prevalence of chronic conditions, poor general health, and disability. In contrast, Asian Multiracial subgroups (e.g., Asian-Black, Asian-Pacific Islander) more often had the lowest prevalence, though Asian-White adults were not consistently the healthiest subgroup. Differences across Multiracial subgroups exceeded 20 percentage points for nearly half of all outcomes. Wide health variation among Multiracial adults is masked by common aggregation practices. Subgroups with the highest burden may be overlooked if data are not routinely disaggregated. Public health surveillance systems should expand capacity to collect and report disaggregated race and ethnicity data to better inform prevention strategies.

Handbook on Public Policy and Food Security

2025-06-20
Andrew Bennie | South African Journal of International Affairs

Mortality Outcomes for Survivors of Cancer With Food Insecurity in the US

2025-06-20
John C. Lin , Jiaxuan Sun , Ruiqi Yan +4 more | JAMA Health Forum
Importance Food insecurity, which is characterized by limited or uncertain access to adequate food, affects approximately 40 million individuals in the US, including many patients with cancer. Understanding the association 
 Importance Food insecurity, which is characterized by limited or uncertain access to adequate food, affects approximately 40 million individuals in the US, including many patients with cancer. Understanding the association between food insecurity and cancer mortality is crucial for improving patient outcomes and addressing health disparities. Objective To investigate the association of food insecurity with cancer-specific and all-cause mortality among US adults with a diagnosis of cancer. Design, Setting, and Participants This cohort study used nationally representative data from the 2011 to 2012 National Health Interview Survey that were linked to the National Death Index, with mortality follow-up through December 31, 2019. It included 5603 respondents to the National Health Interview Survey 40 years and older who reported receiving a diagnosis of cancer and responded to food security questions. Exposure Food insecurity was measured using a validated 10-item National Center for Health Statistics food insecurity scale, categorized as food secure (0-2) or food insecure (3-10) based on US Department of Agriculture guidelines. Main Outcomes and Measures The primary outcomes were cancer-specific mortality ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes: C00-C97) and all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) for these outcomes, adjusting for age, sex, race and ethnicity, household income, US region, body mass index, smoking, alcohol use, comorbidities, and survey year. Results Among the 5603 participants (mean [SD] age, 67.03 [12.03] years; 3298 female individuals [59%]; 320 Hispanic individuals [6%], 22 Native American individuals [0.4%], 136 non-Hispanic Asian individuals [2%], 529 non-Hispanic Black individuals [9%], 4519 non-Hispanic White individuals [81%], and 75 multiracial or multiethnic individuals [1%]), the prevalence of food insecurity was 10.3% among survivors of cancer. Food insecurity was associated with higher all-cause mortality (HR, 1.28; 95% CI, 1.07-1.53) but not cancer-specific mortality after full adjustment. Subgroup analyses indicated that food insecurity was associated with cancer and all-cause mortality for those individuals with household incomes 200% or greater than the federal poverty level (cancer-specific mortality: HR, 1.93; 95% CI, 1.18-3.15; all-cause mortality: HR, 1.89; 95% CI, 1.34-2.68) and those not receiving food assistance (cancer-specific mortality: HR, 1.42; 95% CI, 1.00-2.01; all-cause mortality: HR, 1.42; 95% CI, 1.14-1.76). However, there was no significant association between food insecurity and cancer-specific or all-cause mortality for people with incomes less than 100% of the federal poverty level and households participating in food assistance programs. Conclusions and Relevance The results of this cohort study suggest that food insecurity is a substantial factor associated with increased mortality among survivors of cancer. Addressing food insecurity through routine screenings and connecting patients with food assistance programs may improve survival outcomes, and further research should examine the longitudinal effects of integrating routine food insecurity screenings within cancer care settings and expanding food assistance program eligibility.

Clinical documentation of social determinants of health and its relationship with COVID-19 outcomes among people with and without HIV

2025-06-20
Xueying Yang , Jiajia Zhang , Yunqing Ma +7 more | JAIDS Journal of Acquired Immune Deficiency Syndromes
Introduction: This study aimed to compare the clinical documentation of social determinants of health (SDoH) data and its associations with COVID-19 clinical outcomes among people with HIV (PWH) and people 
 Introduction: This study aimed to compare the clinical documentation of social determinants of health (SDoH) data and its associations with COVID-19 clinical outcomes among people with HIV (PWH) and people without HIV (PWoH) in the United States (US) using the nationally sampled electronic health records (EHR) repository called the National COVID Cohort Collaborative (N3C). Methods: Information on all adult COVID-19 cases was retrieved in the N3C platform from 2020 through 2023. Under the Super-Utilizer Model, we categorized SDoH measures (identified by ICD-10-CM diagnosis codes [“Z codes”]) into different domains, i.e., community/social domain, socioeconomic domain, and environmental domain. Logistic regression models were employed for analysis. Results: Among 41,759 PWH and 6,795,369 PWoH with a COVID-19 infection, 49.8% and 24.0% had at least one Z code documented in the EHR, respectively. For both PWH and PWoH, problems related to employment and housing in the socioeconomic domain and problems related to legal and psychosocial circumstances in the community/social domain were the most commonly documented Z codes associated with severe COVID-19 outcomes; while problems related to upbringing in community/social domain and economic issues in socioeconomic domain were associated with reduced risk of severe COVID-19 outcomes. Conclusion: While documented Z code associations with severe COVID-19 outcomes were similar between PWH or PWoH, they varied between SDoH factors. Identification of Z code associations with severe COVID-19 related outcomes allows for intervention at the population health level, and even more broadly for tracking and resource allocation by public health officials or policymakers.

Runaway Polarization Is Making Us Sick. Social Science Could Offer an Antidote

2025-06-20
Timothy Callaghan , Matthew Motta | Journal of Health Politics Policy and Law
Abstract Public health in the United States has become deeply polarized. Runaway political polarization is increasingly influencing both American's health attitudes (e.g. supporting health policies and candidates that are hostile 
 Abstract Public health in the United States has become deeply polarized. Runaway political polarization is increasingly influencing both American's health attitudes (e.g. supporting health policies and candidates that are hostile to public health) and behaviors (e.g., whether people take action to protect themselves and others from infectious diseases). In this manuscript, we detail the growing partisan polarization of public health over time, examining partisan polarization and its policy consequences. We then propose a three-pronged path for better understanding and overcoming polarization in health and medicine. First, we call for additional social-scientific research on public health polarization. We highlight the need for health data that includes measures of partisanship as well as the need for appropriate sources of funding to study public health polarization. Second, we point to the need for better health communication interventions to confront polarization that are both scalable in real-world settings and likely to be supported by community partners concerned about appearing ‘political’ in their efforts at health messaging. Finally, we discuss the vital role of clinicians in addressing polarization's impact on health, suggesting strategies for patient engagement and the need for research on the bioethical implications of discussing partisan issues during clinical encounters.

Key aspects of conducting deradicalization efforts among women

2025-06-20
N. Zhetpisbay , U. Kalyakbar , К. Bishmanov +1 more | Eurasian Journal of Religious Studies
The research topic "Key aspects of conducting deradicalization efforts among women" is both relevant and significant. The aim of this study is to analyze the effectiveness of measures aimed at 
 The research topic "Key aspects of conducting deradicalization efforts among women" is both relevant and significant. The aim of this study is to analyze the effectiveness of measures aimed at preventing the radicalization of women and their rehabilitation. The main focus of the work is the study of deradicalization programs for women, the examination of their functioning mechanisms, and the current issues they face. The scientific significance of the study lies in the exploration of the social and psychological aspects of deradicalization, as well as in the investigation of theological corrections and social rehabilitation methods, which help improve the relationship between women and society. The practical significance is reflected in the improvement of methods in this area and in offering effective programs and solutions for social reintegration. The research methodology includes comparative analysis and case study methods. A literature review, an in-depth study of international organizations and data, articles, and documents on the topic of radicalization and deradicalization were conducted. This method allowed for an understanding of the broad spectrum of the issue being studied and identified various approaches and models currently used in different situations around the world. The main results and analysis highlighted the importance of theological corrections and social-psychotherapeutic work within deradicalization programs, as well as emphasized the significant role of social rehabilitation for women and children. Based on the findings, recommendations were made to improve deradicalization processes among women, social rehabilitation, psychological support, and the evalution of the impact of these programs on society. This research holds significant scientific and practical value for the effective reintegration of women into society and overcoming radicalization. Keywords: Deradicalization, Religious Extremism, Women, Terrorist Groups, Social Reintegration

Exposure to pollution and climate change-induced food insecurity on depressive symptoms among adolescents in rural areas of Afghanistan

2025-06-19
Conrad Murendo | Discover Mental Health
Research into how pollution and climate change-induced food insecurity affect adolescents' mental health in Afghanistan is still in its infancy. This study analyses the association between pollution exposure, climate change-induced 
 Research into how pollution and climate change-induced food insecurity affect adolescents' mental health in Afghanistan is still in its infancy. This study analyses the association between pollution exposure, climate change-induced food insecurity and, depressive symptoms among adolescents in Afghanistan. A cross-sectional study was conducted among 1416 adolescents and their 1416 parents and/or caregivers in seven provinces of Afghanistan. Exposure to pollution and climate change-induced food insecurity are the explanatory variables of interest. Mental health was measured by the occurrence of depression. Multivariate logistic regression analysis was used for estimation. The multivariate logistic regression results revealed that adolescents exposed to pollution were 2.66 times more likely to exhibit depressive symptoms (OR = 2.66; p<0.001 ), and the effects were significant for both boys and girls. Adolescents experiencing climate change (drought and floods) induced food insecurity were 1.39 times more likely to exhibit depressive symptoms (OR = 1.30; p<0.05 ). In addition, the study found that the effects of drought and flood induced food insecurity on mental health were pronounced among girls than boys. Exposure to pollution and climate change-induced food insecurity were associated with depressive symptoms among adolescents. The public, private sector, and international organizations should promote pollution, drought, and flood mitigation strategies, as these environmental factors may contribute to mental health challenges among adolescents. There is need for interventions that specifically target female adolescents given their vulnerabilities to climate change-induced food insecurity. There is scope to integrate mental health services, with food security, pollution and climate mitigation interventions in Afghanistan. Policymakers should focus on regular community-based mental health screening programs, training local mental health professionals, and educating adolescents about the symptoms of depression.

Food Security among Urban Households: Status, Determinant Factors and Coping Strategies Evidence From Chiro Town, West Harerge Zone, and Oromia Region, Ethiopia

2025-06-19
Tukur Adamu , Yabsira Abebe Tsehay | Research Square (Research Square)
<title>Abstract</title> This study assessed the food security status, identified determinants, and explored coping strategies among urban households in Chiro Town, Ethiopia. Addressing a research gap focusing on small, rapidly growing 
 <title>Abstract</title> This study assessed the food security status, identified determinants, and explored coping strategies among urban households in Chiro Town, Ethiopia. Addressing a research gap focusing on small, rapidly growing urban centers, the research employed a cross-sectional design and a mixed-method approach, surveying 392 households. Food security was assessed using daily calorie intake, with 2100 kcal per adult equivalent as the threshold. Findings revealed that a considerable portion of urban households faced food insecurity, with 34.44% classified as food insecure, including marginal, moderate, and severe levels. Significant determinants of food security included educational attainment, household income, access to remittances, and homeownership (positive associations), and larger family sizes, higher dependency ratios, and female household headship (negative associations). Occupational status, particularly daily labor, was linked to vulnerability. Households adopted various coping strategies, most notably reducing meals, engaging in daily labor, and borrowing money. More severe strategies, like selling assets or withdrawing children from school, were also employed, highlighting the depth of vulnerability. These results underscore the unique challenges and the need for targeted interventions in such small urban contexts.

The interplay and correlates of agricultural (Farm) and non-agricultural activities to food diversity – linkages to health expenditure

2025-06-19
Katiso Ramalebo , Retius Chifurira , Temesgen Zewotir +1 more | Asian Journal of Agriculture and Rural Development
Literature suggests that a varied and high-quality diet is essential for adequate nutrient intake and improved health outcomes. Despite this knowledge, and considering that agricultural participation can enhance food availability 
 Literature suggests that a varied and high-quality diet is essential for adequate nutrient intake and improved health outcomes. Despite this knowledge, and considering that agricultural participation can enhance food availability and diversity, populations continue to face challenges in achieving dietary diversity due to socioeconomic constraints among a plethora of factors. Understanding this relationship becomes particularly important for Lesotho, where such insights can inform strategies to promote dietary diversity, improve public health, and reduce healthcare costs. This study utilized data from the Household Budget Survey to examine how household food consumption patterns, socioeconomic factors, and agricultural participation influence food diversity and health-related costs. Using Partial Least Squares-Structural Equation Modeling (PLS-SEM), we analyzed the relationships between these variables to gain a nuanced understanding of their interplay. Results reveal that food diversity is shaped by multiple factors, including agricultural participation, which directly affects health outcomes. Household characteristics, such as income, household size, and education level of the household head, significantly predict both food diversity and health expenditure. These findings underscore that supporting agricultural engagement and promoting dietary diversity can be cost-effective strategies to improve nutrition and reduce healthcare costs in Lesotho. Policymakers should focus interventions in these areas.

How a Microfinance-Based Livelihood Program can Combat Food Insecurity Among Families of Children With Cerebral Palsy in Bangladesh—Evidence From a Randomized Control Trial

2025-06-19
Md Nuruzzaman Khan , Mahmudul Hassan Al Imam , Israt Jahan +3 more | Food and Nutrition Bulletin
Background Household food insecurity is a critical concern for ultra-poor families in low- and middle-income countries like Bangladesh, particularly those with members who have disabilities. The COVID-19 pandemic has worsened 
 Background Household food insecurity is a critical concern for ultra-poor families in low- and middle-income countries like Bangladesh, particularly those with members who have disabilities. The COVID-19 pandemic has worsened this situation. Objective This study aimed to assess the impact of microfinance-based livelihood programs on food insecurity in ultra-poor families with members affected by cerebral palsy in Bangladesh. Methods Data were extracted from the SUPPORT CP trial for 251 children with cerebral palsy. The Household Food Insecurity Access Scale score was the outcome variable. The explanatory variable was the intervention type, dividing the sample into 3 arms: Arm C (care as usual), Arm B (Community-Based Rehabilitation [CBR]), and Arm A (CBR with the integrated microfinance-based livelihood program [IMCBR]). Both linear regression and the Generalized Estimating Equations model were used to determine the association of outcome variable with explanatory variables adjusting for covariates. Results We found a consistent level of household food insecurity across each time point, with a significant increase in the midline during the peak of COVID-19 pandemic in 2020. However, following the end of the COVID-19 pandemic, both Arms A and B, where interventions were provided, reported a significant decline in food insecurity. Notably, Arm A, where IMCBR was provided, exhibited the fastest decrease in food insecurity followed by Arm B, where only CBR was provided, compared to Arm C. Conclusion Microfinance programs can reduce food insecurity among families of children with cerebral palsy in Bangladesh, especially during crises like COVID-19, underscoring the need to integrate them with tailored disability rehabilitation services.

Food insecurity modifies the association between the gut microbiome and the risk of cognitive impairment in adults

2025-06-18
Shoshannah Eggers , Zachary E. Hoggarth , Kiran Nagdeo +7 more | npj Aging

Implementation of Social Determinants of Health Screening in a Student-Run Physical Therapy Pro Bono Clinic

2025-06-18
Laurie Stickler , Brianna Chesser , Todd Sander +1 more | Journal of Student-Run Clinics
Addressing non-medical factors impacting health is essential for health equity. While addressing social determinants of health (SDOH) has become a standard in primary care, it is vital within rehabilitation services 
 Addressing non-medical factors impacting health is essential for health equity. While addressing social determinants of health (SDOH) has become a standard in primary care, it is vital within rehabilitation services as well. This report describes the implementation of screening for SDOH at a university pro bono physical therapy clinic in an urban community. Insights into best practices for implementation were outlined and a nine-question SDOH screening questionnaire was developed. Baseline data of 80 clients identified access to healthy food and payment of basic expenses as the most common SDOH requiring follow-up. Several considerations for implementation were identified including the complex nature of factors impacting care and the need for thoughtful follow-up questions to provide appropriate resources and care.

Food Insecurity in US Surgical Patients

2025-06-18
Annabelle Jones , Anam N. Ehsan , Coral Katave +5 more | JAMA Surgery
Importance Food insecurity, defined as uncertain access to enough food for a healthy life, is a growing issue in the US. While its link to chronic conditions is well documented, 
 Importance Food insecurity, defined as uncertain access to enough food for a healthy life, is a growing issue in the US. While its link to chronic conditions is well documented, little is known regarding its impact on surgical patients. Objective To assess food insecurity, identify associated characteristics, and measure the rate of Supplemental Nutrition Assistance Program (SNAP) enrollment among surgical patients using a nationally representative sample. Design, Setting, and Participants This was a cross-sectional study using National Health Interview Survey (NHIS) data from 2011 through 2018. These data were analyzed from February 2024 through April 2025. Multivariable logistic regression models were used to analyze the association between surgery, food insecurity, and enrollment in SNAP. Data for this study came from the NHIS, a nationally representative survey used for health information, health access, and health behaviors of the civilian, noninstitutionalized US population, enabling broad applicability to surgical patients. The study included 254 283 individuals with data on surgery within the past year and 30-day food insecurity. Surgical and nonsurgical cohorts were created based on answers to, “During the past 12 months, have you had surgery or other surgical procedures as an inpatient or outpatient?” Exposures The main exposure included undergoing surgery in the past year. Other exposures were age, race, sex, employment status, household income, marital status, number of family members in the household, geographic region, health status, and insurance status. Main Outcomes and Measures The proportion of food insecurity among the surgical cohort was the main outcome. Secondary outcomes included factors linked to food insecurity and SNAP enrollment, especially for those with incomes below 200% of the federal poverty level. Results Surgical patients (13 180 male [40.2%] and 19 643 female [59.8%]) reported higher food insecurity prevalence (11.6%) than nonsurgical patients (100 924 male [45.6%] and 120 536 female [54.4%]) (10.5%). Adjusted analyses indicated significantly higher odds of food insecurity among surgical patients (odds ratio, 1.12; 95% CI, 1.07-1.18; P &amp;amp;lt; .001). Food insecurity was strongly linked to lower income and poor health. SNAP enrollment was 16% overall and 40% among surgical patients with incomes less than 200% federal poverty level, associated with younger, low-income, unemployed, less educated, or publicly insured patients. Conclusions and Relevance Food insecurity is a significant burden among surgical patients. Interventions, including food insecurity screening, may improve food access and health outcomes in this cohort.

Addressing Food Insecurity Among US Surgical Patients

2025-06-18
Pooja Podugu , Vanessa P. Ho , Marie Crandall | JAMA Surgery

Good Outcomes Require Good Nutrition, and Good Nutrition Rests Upon Sound Policy

2025-06-18
Brendan M. Patterson | Journal of Bone and Joint Surgery

Urban-Rural Disparities in Perceived Benefits and Challenges for Supplemental Nutrition Assistance Program (SNAP) Participation

2025-06-18
Tirna Purkait , Dipti Dev , Natalie A. Koziol +3 more | American Journal of Health Promotion
Purpose This research investigates the perceived benefits and challenges of participating in the Supplemental Nutrition Assistance Program (SNAP) among households with young children across urban and rural Nebraska, aiming to 
 Purpose This research investigates the perceived benefits and challenges of participating in the Supplemental Nutrition Assistance Program (SNAP) among households with young children across urban and rural Nebraska, aiming to address the limited exploration of disparities in its reach. Design Cross-Sectional (SNAP-Ed Needs and Assets Assessment). Setting Households across Nebraska. Participants Low-income families with at least 1 child aged 6 or younger (n = 1040). Measures Perceived benefits and challenges to SNAP participation across urban-rural populations, controlling for race, income, and education. Analysis Chi-square tests and logistic regression with Benjamini-Hochberg correction. Results Overall, financial need was perceived as the top reported benefit, while time and efforts for recertification were the top challenge. Rural residents perceived financial need ( P &lt; 001) and ability to have enough healthy food ( P &lt; 05) as major drivers for SNAP enrollment, whereas urban residents perceived previous SNAP-Ed participation ( P &lt; 001) and positive peer influence ( P &lt; 01) as benefits. Rural respondents perceived greater challenges in SNAP application requiring more time and effort ( P &lt; 001), while urban respondents had significantly higher concerns about native language accessibility ( P &lt; 001), poor customer service ( P &lt; 05), and unwillingness to depend on government agencies ( P &lt; 05). Conclusion Geographically and culturally tailored SNAP-Ed interventions and streamlined application processes are required to address the urban-rural disparities.

“A little bit to spare on food” Food security challenges affecting refugee populations during early resettlement in Australia: settlement service provider perspectives

2025-06-18
Julie Maree Wood , Rebecca Lindberg , Alison Booth +1 more | Appetite

A Systematic Review of “Food Is Medicine” Randomized Controlled Trials for Noncommunicable Disease in the United States: A Scientific Statement From the American Heart Association

2025-06-18
Hilary K. Seligman , Sonia Y. Angell , Seth A. Berkowitz +7 more | Circulation
Poor diet quality is a leading risk factor for cardiometabolic disease (ie, diabetes and diseases associated with metabolism and inflammation), which is present in about half of American adults. Support 
 Poor diet quality is a leading risk factor for cardiometabolic disease (ie, diabetes and diseases associated with metabolism and inflammation), which is present in about half of American adults. Support has grown for incorporating the provision of healthy food as a complement to or a component of clinical care. Such “Food Is Medicine” programs provide free or subsidized healthy food directly to patients in close coordination with the health care system. In this review, we systematically examined published randomized controlled trials examining Food Is Medicine programs in the United States, categorizing them into different stages of development using the National Institutes of Health Model for Behavioral Intervention Development. This review identified a total of 14 randomized controlled trials of Food Is Medicine interventions in the United States with noncommunicable disease outcomes, more than one-third of which were early-stage smaller-scale trials (stage 1 randomized controlled trials). Broad variations in populations enrolled; intervention design, duration, and intensity; and outcomes precluded many direct comparisons between studies. Randomized controlled trial data were generally consistent with findings in the observational literature, indicating that common Food Is Medicine approaches often positively influence diet quality and food security, which are theorized to be key mediators for clinical outcomes. However, the impact on clinical outcomes was inconsistent and often failed to reach statistical significance. These observations highlight the need for larger, higher-quality Food Is Medicine studies focusing on the measurement of clinical outcomes within well-designed programs and the need for additional randomized controlled trials that more systematically map out the relationship between participation in different types of Food Is Medicine programs and health outcomes.

When Access Is Not Enough: The Role of Utilization Barriers in Nutrition Security and Cardiometabolic Risk

2025-06-18
Maha Almohamad , Ruosha Li , Natalia I. Heredia +4 more | Nutrients
Background: Food and nutrition security are key social determinants of cardiometabolic health. While food security reflects access to sufficient food, nutrition security incorporates the quality, consistency, and usability of food 
 Background: Food and nutrition security are key social determinants of cardiometabolic health. While food security reflects access to sufficient food, nutrition security incorporates the quality, consistency, and usability of food that supports long-term health. However, few studies have examined how household-level barriers to food utilization shape these relationships. Objective: This study assessed whether tangible (e.g., equipment, storage) and intangible (e.g., time, knowledge) food utilization barriers modify the associations between food and nutrition security and cardiometabolic outcomes in low-income adults. Methods: A cross-sectional survey was conducted among 486 low-income adults across five U.S. states. Participants reported household food security (USDA 18-item module), nutrition security (four-item scale), and utilization barriers (eight-item scale, categorized into tangible and intangible subscales). Self-reported diagnoses of hypertension, hyperlipidemia, and diabetes were combined into a cardiometabolic outcome. Mixed-effects logistic regression models, adjusted for sociodemographic and program participation factors, were used to assess associations and effect modification. Results: Higher nutrition security was associated with lower odds of cardiometabolic conditions (AOR = 0.59; 95% CI: 0.41–0.83). Tangible barriers significantly modified the relationship between nutrition security and hypertension (p-interaction = 0.04), with stronger protective effects observed in households without such barriers. No significant moderation effects were found for intangible barriers or for food security. Conclusions: Tangible household barriers influence the protective association between nutrition security and cardiometabolic outcomes. Public health strategies should address not only food access but also the practical resources required to store, prepare, and consume healthy foods effectively.

LGBTQ+ “Radical Resilience is Engaging with the World on Fire Without Burning Up or Burning Out”

2025-06-18
Linda Hoeptner Poling , Karen Keifer‐Boyd | Routledge eBooks

Food insecurity and the risk of diabetes: understanding the role of BMI as a mediator and moderator

2025-06-17
Cindy W. Leung , Ana Margarita Larrañaga , Minal Patel +6 more | Obesity
Abstract Objective This retrospective cohort study examined BMI as a mediator and moderator of the association between food insecurity and diabetes. Methods Data came from the electronic health records of 
 Abstract Objective This retrospective cohort study examined BMI as a mediator and moderator of the association between food insecurity and diabetes. Methods Data came from the electronic health records of 74,174 primary care patients at a large academic medical center. We used multivariate Poisson regression models to examine the association between food insecurity and diabetes. We used causal mediation analysis to evaluate the direct and indirect effects by which BMI mediates and moderates this association and the extent to which these effects varied by age, sex, and race and ethnicity. Results During the 5‐year period, 6.2% of patients were newly diagnosed with diabetes. Food insecurity was associated with a higher risk of diabetes (relative risk [RR] 1.19, 95% CI: 1.03–1.36) after multivariate adjustment. In mediation analysis, BMI was a significant mediator of the association between food insecurity and diabetes (natural indirect effect: RR 1.10, 95% CI: 1.06–1.14). When accounting for an interaction with BMI, BMI remained a significant mediator (natural indirect effect: RR 1.12, 95% CI: 1.0–1.17). In subgroup analyses, the mediator–moderator effect of BMI was stronger among adults &lt;45 years old and female patients; there were no differences by race or ethnicity. Conclusions Our findings support BMI as a mediator and moderator of the association between food insecurity and diabetes.

Prevalence and Predictors of Food Insecurity among Adolescents in Households in the Volta and Oti Regions of Ghana: A Cross-Sectional Study

2025-06-17
Norbert Ndaah Amuna , Deda Ogum Alangea , Juliana Yartey Enos +3 more | medRxiv (Cold Spring Harbor Laboratory)
Abstract Background Food insecurity poses a threat to adolescent nutrition and health, especially in low- and middle-income countries (LMICs), with potential lifelong consequences. This study assessed the prevalence and drivers 
 Abstract Background Food insecurity poses a threat to adolescent nutrition and health, especially in low- and middle-income countries (LMICs), with potential lifelong consequences. This study assessed the prevalence and drivers of adolescent food insecurity in Ghana’s Volta and Oti regions. Objectives To assess the prevalence and predictors of food insecurity among adolescents in the Volta and Oti regions of Ghana. Methods Design A community-based cross-sectional study Setting The study was conducted in the Volta and Oti regions of Ghana. Participants The sample included 667 adolescents aged 10-19 years. Outcome Measure We measured food insecurity using the Household Food Insecurity Access Scale (HFIAS). Data were collected using a two-stage sampling approach. Adolescents food insecurity status was categorised into food secure, mildly, moderately, or severely food insecure. Multivariable logistic regression analysis was employed to identify the risk factors associated with food insecurity. Results Approximately 47.5% of the surveyed adolescents reported experiencing periods of inadequate food intake during the 12 months preceding the survey. Among adolescents experiencing food scarcity, the periods from January to March (32.2%) and April to June (28.8%) were identified as the peak times of limited food availability. In total, 61% of adolescents in the Volta and Oti regions experienced food insecurity, with 23.5% classified as severely food insecure, 47.7% worried about not having enough food, and 54% could not access preferred foods due to limited resources. Approximately 50.1% consumed a monotonous diet and 44.1% consumed foods they perceived as socially unacceptable. Urban residence (aOR = 0.67; CI=0.46-0.97), higher maternal education (aOR=0.41; CI=0.22-0.78), and higher wealth (aOR=0.02; CI=0.0-0.09) were associated with reduced odds of food insecurity. Conclusion There was a high prevalence of adolescent food insecurity in the Volta and Oti regions of Ghana. This has profound implications for adolescent nutrition, health, and overall well-being. Peak periods of food scarcity align with the broader seasonal food scarcity patterns and lean seasons in Ghana. The high rates of food insecurity directly impede the goal of achieving SDG 2 and 3. Key predictors include urban-rural differences, maternal education, and wealth. Urgent action is needed to address these factors and ensure consistent access to nutritious food. Strengths and limitations of this study We used the widely accepted Household Food Insecurity Access Scale (HFIAS), a standardized and comprehensive tool for assessment of food insecurity. We employed multistage systematic sampling, enhancing representativeness and generalizability within the Volta and Oti regions. A cross-sectional design limits the ability to establish causal relationships. Potential self-reporting bias may affect data accuracy due to socially desirable or inaccurate responses. Findings may not be generalisable beyond the studied regions because of socioeconomic and cultural differences.

Assess The Dietary Habits and Their Associative Factors Among Hostel Nursing Girls

2025-06-17
Ritarani Nayak , Puspanjali Mohapatro , Kabita Puhan +3 more | Journal of Neonatal Surgery
Background: Healthy eating is essential for maintaining overall well-being, yet unhealthy dietary habits are increasingly prevalent among young adults, leading to rising obesity rates and associated health concerns. Hostel students, 
 Background: Healthy eating is essential for maintaining overall well-being, yet unhealthy dietary habits are increasingly prevalent among young adults, leading to rising obesity rates and associated health concerns. Hostel students, particularly nursing students, often face challenges in maintaining a balanced diet due to various influencing factors such as peer pressure, media exposure, and personal preferences. Objectives: This study aimed to assess the dietary habits of hostel nursing girls and examine the associative factors influencing their food choices. Methodology: A non-experimental survey approach was employed, involving 300 hostel girls from Ladies Hostel-II, Campus II, BBSR, Odisha. Purposive sampling was used for participant selection. Data were collected through structured interviews using rating scales and yes/no questionnaires. The analysis focused on identifying key factors affecting dietary habits and their association with socio-demographic characteristics. Results: Findings revealed that 53.88% of students' food choices were influenced by personal preferences, 56% by mass media and advertisements, and 27% by artificial food colors and flavors. Peer influence played a major role, affecting 60.5% of students, while psychological (34.66%) and social factors (44%) also impacted dietary habits. Significant associations were observed between dietary patterns and factors such as age, course and year of study, height, BMI, and family income (p &lt; 0.05). However, no significant correlation was found with religion, marital status, or weight. Conclusion: The study highlights that hostel nursing girls primarily follow an average dietary pattern, with a notable tendency toward unhealthy food choices influenced by peers and media exposure. Awareness programs on the negative effects of unhealthy eating habits are essential to promote healthier dietary practices among students.

O consumo de açĂșcar e o risco de lesĂ”es de cĂĄrie em adolescentes

2025-06-17
Ana Albuquerque , Bernardo Rurik Aparecido Gomes , C Silva +3 more | DELOS Desarrollo Local Sostenible
Este trabalho tem como intuito alertar os adolescentes ao consumo de açĂșcar e o risco de cĂĄrie, pois estĂĄ cada vez mais frequente o aumento de incidĂȘncia de cĂĄrie na 
 Este trabalho tem como intuito alertar os adolescentes ao consumo de açĂșcar e o risco de cĂĄrie, pois estĂĄ cada vez mais frequente o aumento de incidĂȘncia de cĂĄrie na adolescĂȘncia, sendo um problema frequente nessa faixa etĂĄria, o objetivo principal Ă© a conscientização necessĂĄria para ter uma boa higienização bucal e hĂĄbitos adequados de saĂșde, pois nĂŁo optam por uma alimentação saudĂĄvel com baixo nĂ­veis de açĂșcares, sendo assim essencial este trabalho como forma de cuidado e conscientização para estes jovens. Trata-se de uma revisĂŁo bibliogrĂĄfica, feito a partir de artigos jĂĄ publicados em portuguĂȘs e inglĂȘs nos perĂ­odos de 2020 a 2025, encontrados por meio de pesquisas na base de dados do Google AcadĂȘmico e Pubmed, utilizando os seguintes descritores em lĂ­ngua portuguesa e inglesa: “O consumo de açĂșcar entre os adolescentes”, “A incidĂȘncia de cĂĄrie com consumo de açĂșcar na adolescĂȘncia”, “O risco da cĂĄrie em adolescentes”. Assim, de 30 artigos foram selecionados apenas aqueles relacionados ao consumo de açĂșcar e a incidĂȘncia de cĂĄrie em adolescentes, desenvolvimento da cĂĄrie e sua relação com o alto consumo de açĂșcar. Chegando no total de 10 artigos que deram conhecimentos suficientes para prosseguir no trabalho, passando as informaçÔes principais para optarem por comidas mais saudĂĄveis e uma boa higiene bucal para evitar a incidĂȘncia de cĂĄrie.