Medical Mistrust Among Food Insecure Individuals in Appalachia.

This study focused on the relationship between food insecurity and medical mistrust within Appalachia. Food insecurity has negative consequences on health, while medical mistrust can lead to a decrease in health care use, creating additive consequences to already vulnerable populations. Medical mistrust has been defined in various ways, with measures addressing health care organizations and individual health care providers. To determine whether food insecurity has an additive impact on medical mistrust, a cross-sectional survey was completed by 248 residents in Appalachia Ohio while attending community or mobile clinics, food banks, or the county health department. More than one-quarter of the respondents had high levels of mistrust toward health care organizations. Those with high food insecurity levels were more likely to have higher levels of medical mistrust than those with lower levels of food insecurity. Individuals with higher self-identified health issues and older participants had higher medical mistrust scores. Screening for food insecurity in primary care can reduce the impact of mistrust on patient adherence and health care access by increasing patient-centered communication. These findings present a unique perspective on how to identify and mitigate medical mistrust within Appalachia and call attention to the need for further research on the root causes among food insecure residents.

Reprint of: Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States.

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Food insecurity is associated with disordered eating behaviors in NCAA division 1 male collegiate athletes.

Objective: To assess the relationship of high school and collegiate household food security to current disordered food consumption behaviors in a sample of NCAA Division 1 male, collegiate athletes. Participants: Male athletes, 18 years and older from a Southeastern Conference university in August-September 2016. Methods: Cross-sectional survey including food security disordered eating behavior, and food hoarding questions. Results: Among participants (n = 111), high school food insecurity was significantly correlated with a preoccupation with food, but not binge eating in college. Collegiate food insecurity was significantly correlated with a preoccupation with, and hoarding of, food in college. Conclusions: Among male collegiate athletes, both high school and collegiate food insecurity are associated with preoccupation with food, and collegiate food insecurity is associated with food hoarding. Screening for both high school and collegiate food insecurity and disordered behaviors in athletes is warranted. Future research in a larger sample, including females, across institutions is warranted.

Food Insecurity Is Associated With Poorer Glycemic Control in Patients Receiving Free Versus Fee-Based Care.

IN BRIEF This study examined differences in household food security (HFS), household adult food security (HAFS), and indicators of diabetes management between clients using free and fee-for-service clinics for diabetes care and management. The study's 166 participants (free clinic, n = 41; fee-for-service clinic, n =125) had a mean age of 53 ± 16 years and were primarily Caucasian (n = 147 [91.9%]). Both HFS (P <0.001) and HAFS (P <0.001) differed between the clinic groups, as did A1C (free clinic 8.7 ± 1.7%; fee-for-service 7.8 ± 1.6%; P = 0.005). A1C increased as HFS (r = 0.293, P <0.001) and HAFS (r = 0.288, P = 0.001) worsened.

Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States.

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Cardiovascular Disease Risk Factors After an Employer-Based Risk Reduction Program: An Observational Cohort Study.

CONTEXT: The burden of cardiovascular disease (CVD) continues to be a public health concern. Workplace interventions that focus on modifying lifestyle habits may reduce CVD risk factors in people at risk. OBJECTIVE: To determine the effectiveness of a comprehensive lifestyle intervention program that integrated dietary modification, physical activity, stress management, and behavior modification counseling to reduce the risk of CVD in at-risk adults. METHODS: Twelve 1-year cohorts who participated in a comprehensive employer-sponsored lifestyle intervention program targeting diet, exercise, behavior modification, and stress management between 2006 and 2010 at a rural university in Appalachian Ohio were studied. Body composition, fasting glucose and lipid levels, and maximal oxygen consumption were measured at baseline, after 100 days, and at 1 year. Repeated-measures analyses of variance were conducted to compare measures at baseline with measures at 100 days and at 1 year. RESULTS: Seventy-four participants (57 women [77.1%], 17 men [22.9%]) of 97 completed the program (76.3% completion rate). Body weight (P<.001); percentage of body fat (P<.001); fat mass (P<.001); body mass index (P<.001); waist circumference (P<.001); blood levels of high-density lipoprotein (P=.035), low-density lipoprotein (P=.011), and glucose (P=.008); serum triglyceride levels (P=.019); blood pressure (systolic P=.028; diastolic, P=.001); and maximal oxygen consumption (P<.001) improved from baseline to 1 year after the intervention. Lean body mass (P=.111) and total cholesterol (P=.053) did not improve. CONCLUSIONS: This employer-based lifestyle intervention program was effective in reducing CVD risk factors after 1 year of treatment. Future studies should examine the effects of the intervention at 2 and 5 years to further assess long-term adoption of the lifestyle changes and maintenance of health promoted by this program.

Food Insecurity and Its Association With Central Obesity and Other Markers of Metabolic Syndrome Among Persons Aged 12 to 18 Years in the United States.

CONTEXT: Food insecurity is a preventable health threat and may precipitate central obesity and metabolic syndrome in children and adolescents in the United States. OBJECTIVE: To examine (1) health by household food security status; and (2) differences and prevalence of central obesity among persons aged 12 to 18 years in the United States. METHODS: The National Health and Nutrition Examination Survey was administered to a cross-sectional sample of persons aged 12 to 18 years in 1999 to 2006. Controlling for age, race/ethnicity, and sex differences in mean obesity and chronic disease factors across levels of food insecurity (analysis of covariance [Bonferroni post hoc] and ORs [logistic regression analyses]) were examined, as were differences in the rates of risk factors (χ(2) statistics). RESULTS: A total of 7435 participants were analyzed. Those from marginally food secure (n=751) and low-food secure (n=1206) (population size estimate, 26,714,182) households were significantly more likely than their high-food secure counterparts (n=4831) to be overweight (P=.036) (OR, 1.44), and those from marginally food secure households were 1.3-times more likely to be obese (P=.036). Nearly 25% of respondents from marginally food secure, low-food secure, and very low-food secure (n=647) households reported central obesity (P=.002), which was 1.4 to 1.5 times more likely than those from high-food secure households. Participants from high-food secure households had significantly higher mean high-density lipoprotein values (P=.019). Risk factors indicative of metabolic syndrome were present in 3.1%. CONCLUSION: Household food insecurity was associated with an increased likelihood of being overweight and having central obesity. Limitations included the use of cross-sectional data and some self-reported data and the inability to control for all moderating variables in obesity and overall health status.

Role of a food box program in fruit and vegetable consumption and food security.

PURPOSE: We examined whether participation in a food box program has a positive effect on fruit and vegetable consumption and food security. METHODS: Participants and nonparticipants in a food box program were surveyed to determine differences between the two groups and change over time. RESULTS: Fruit and vegetable intake declined in those who left the program after several months, and intake of fruit, carrots, and vegetables was lower among those who had left than among those who remained in the program. Food insecurity was associated with lower intakes of fruit and vegetables. CONCLUSIONS: Participation in a food box program can provide some benefit in terms of increased fruit and vegetable consumption for those who use the program regularly. Increasing the frequency of the box and encouraging continued use may improve these effects.

Position of the American Dietetic Association: food insecurity in the United States.

It is the position of the American Dietetic Association that systematic and sustained action is needed to achieve food and nutrition security for all in the United States. To eliminate food insecurity, interventions are needed, including adequate funding for and increased utilization of food and nutrition assistance programs, inclusion of food and nutrition education in such programs, and innovative programs to promote and support individual and household economic self-sufficiency. More than 49 million individuals living in the United States experienced food insecurity in 2008. Negative nutrition and non-nutrition-related outcomes have been associated with food insecurity in children, adolescents, and adults, including substandard academic achievement, inadequate intake of key nutrients, poor health, increased risk for and development of chronic disease, poor disease management, and poor psychological and cognitive functioning. Registered dietitians and dietetic technicians, registered, can play key roles in ending food insecurity and are uniquely positioned to make valuable contributions through provision of comprehensive food and nutrition education; competent and collaborative practice; innovative research related to accessing a safe, secure, and sustainable food supply; and advocacy efforts at the local, state, regional, and national levels.

Food security status and produce intake and behaviors of Special Supplemental Nutrition Program for Women, Infants, and Children and Farmers' Market Nutrition Program participants.

OBJECTIVE: This study identified differences between women from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)- and WIC/Farmers' Market Nutrition Program-participating households regarding household food security status, fruit and vegetable intake and behaviors, perceived diet quality, and education level; and assessed the relationship between household food security status and perceived diet quality and perceived health. DESIGN, SUBJECTS/SETTING: Cross-sectional survey of women from Athens County, Ohio (WIC, n=829; Farmers' Market Nutrition Program, n=246) living in WIC households. RESULTS: Of 228 participants completing the food security portion of the survey, 61 (26.8%) were living in food secure households, while 47 (20.6%), 75 (32.9%), and 45 (19.7%) were living in households at risk for (marginal) food insecurity, with low food security, and with very low food security, respectively. For the entire sample, food insecurity was associated with poorer diet quality (r=-0.248, P<0.001). Food security status (chi(2)=2.117, P=0.548) did not differ between groups. Farmers' Market Nutrition Program reported higher education levels (P=0.027). Unlike fruit intake (t test, P=0.769), vegetable intake servings were greater among Farmers' Market Nutrition Program (2.2+/-1.2), compared to WIC (1.9+/-1.0) (t test, P=0.040). Both perceived benefit (chi(2)=4.574, P=0.032) and perceived diet quality (chi(2)=7.219, P=0.027) were greater for Farmers' Market Nutrition Program. CONCLUSIONS: Farmers' Market Nutrition Program participants exhibit more indicators of a healthful diet, but appear not to be more food secure. Nutrition education regarding the benefits of fresh produce intake can help to improve diet quality and increase Farmers' Market Nutrition Program participation.

Household food insecurity is inversely associated with social capital and health in females from special supplemental nutrition program for women, infants, and children households in Appalachian Ohio.

Food insecurity has been negatively associated with social capital (a measure of perceived social trust and community reciprocity) and health status. Yet, these factors have not been studied extensively among women from households participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or the WIC Farmers' Market Nutrition Program. A cross-sectional, self-administered, mailed survey was conducted in Athens County, Ohio, to examine the household food security status, social capital, and self-rated health status of women from households receiving WIC benefits alone (n=170) and those from households receiving both WIC and Farmers' Market Nutrition Program benefits (n=65), as well as the relationship of food security, social capital, and self-rated health status. Household food security and perceived health status were not significantly different between groups; however, high social capital was greater (chi(2)=8.156, P=0.004) among WIC, compared to WIC/Farmers' Market Nutrition Program group respondents. Overall, household food insecurity was inversely associated with perceived health status (r=-0.229, P=0.001) and social capital (r=0.337, P<0.001). Enabling networking among clients, leading to client-facilitated programs and projects, and developing programs that strengthen social capital, including community-based mentoring programs and nutrition education programs that are linked to community-based activities, are needed, as is additional research to verify these findings.

Knowledge and practices of Ohio nurse practitioners regarding food access of patients.

PURPOSES: To assess the self-identified food security knowledge and practices of nurse practitioners (NPs) in Ohio and the relationships of food security knowledge and practices to NP characteristics. DATA SOURCES: This study utilized a survey approach for data collection. Participants were licensed NPs with prescriptive authority in Ohio who were randomly selected from the Ohio licensure list and responded to a questionnaire (n= 288) with demographic and food security-related questions. CONCLUSIONS: Less than one third of respondents agreed or strongly agreed that they were knowledgeable about the topic of food security. Education of NPs about food insecurity and about incorporation of food security principles into the healthcare process is needed. IMPLICATIONS FOR PRACTICE: Food insecurity can negatively impact compliance to prescribed treatments. NPs should address food security issues in order to provide specialized, individualized care to patients in order to achieve positive outcomes. Through evaluation of patients' food access, and factors that are related to food insecurity, this can be achieved.

Diabetes risk and obesity in food-insecure households in rural Appalachian Ohio.

INTRODUCTION: In 2003, 11.2% of U.S. households were at some time food insecure; in 1999, when this study was conducted, 10.1% of U.S. households were at some time food insecure. A previous study of individuals from an Appalachian Ohio county suggested that food insecurity is associated with poorer self-reported health status. This larger study assesses the relationship of food security to clinical measurements of several chronic health risks among residents in six rural Appalachian Ohio counties. METHODS: Data for this report are a subset of data gathered by surveys completed by 2580 individuals at community-based sites and by on-site, limited clinical health assessments conducted with a subsample of 808 participants. Descriptive statistics were calculated to describe the sample. Student t tests were used to compare measured BMI, diastolic blood pressure, total cholesterol, random blood glucose, HbA1c levels, and hemoglobin between individuals from food-secure and food-insecure households. RESULTS: Our sample had about three times the level of food insecurity (with and without hunger) and more than seven times the level of food insecurity with hunger as the state population. Diastolic blood pressure, total cholesterol, random blood glucose, HbA1c, and hemoglobin did not differ by food security status (P > .05 for all); however, BMI was greater among individuals from food-insecure households, especially among women (t1272 = -2.0, P = .04), than among their food-secure counterparts. Obesity was greater among individuals from food-insecure households (48.1%) than among those from food-secure households (35.1%, P < .001). CONCLUSION: This study examines possible causes and consequences of food insecurity as it relates to chronic disease development. Further investigation is needed in this community and in other Appalachian communities, as well as the United States, to determine relationships between food insecurity and chronic disease development and management.

Position of the American Dietetic Association: food insecurity and hunger in the United States.

It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the United States. The Association believes that immediate and long-range interventions are needed, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, to end food insecurity and hunger in the United States. Food insecurity continues to exist in the United States, with over 38 million people experiencing it sometime in 2004. Negative nutritional and nonnutritional outcomes have been associated with food insecurity in adults, adolescents, and children, including poor dietary intake and nutritional status, poor health, increased risk for the development of chronic diseases, poor psychological and cognitive functioning, and substandard academic achievement. Dietetics professionals can play a key role in ending food insecurity and hunger and are uniquely positioned to make valuable contributions through provision of comprehensive food and nutrition education, competent and collaborative practice, innovative research related to accessing a safe and secure food supply, and advocacy efforts at the local, state, regional, and national levels.

Self-identified knowledge and practices of family physicians in Appalachian Ohio regarding food acquisition of patients.

This study assessed the self-identified food security knowledge and practices of family physicians practicing in Appalachian Ohio, along with related factors, using a 17-item survey. Respondents (n=189, 42.2%) were primarily male (n=151, 79.9%), white (n=172, 91%), US citizens (n=182, 96.8%), rural inhabitants (n=137, 72.5%), and doctors of medicine (n=19, 63.3%). Only 29 (16.0%) of the family physicians strongly agreed (n=2, 1.1%) or agreed (n=27, 14.9%) that they were knowledgeable about food security. A food security practice score (n=189, 3.4+/-2.4) was computed using a multi-item question (Cronbach's alpha=0.76). Food security knowledge was related to (Kendall's tau) age (0.137, P =.028), years as a physician (0.162, P =.004), and food security practice score (0.161, P =.007). Family physicians involved in improving community food security had greater food security practice scores (n=43, 4.9+/-2.9), compared with those who did not (n=138, 2.9+/-2.0) ( P <.001). Education of family physicians about food insecurity and considering food security in practice is warranted.

Food security status of households in Appalachian Ohio with children in Head Start.

This study measured food security and hunger of households involved in Head Start in a rural Appalachian county and assessed factors that could affect food security and hunger. A convenience sample of households with children enrolled in the Head Start program in Athens County, Ohio, were sampled (n=710), with adults from 297 (42%) households responding. The survey instrument included the 18-question US Household Food Security Survey Module for measuring hunger and food insecurity. Of those responding, 152 households (51.2%) were food secure and 145 (48.8%) were food insecure. Ninety (30.3%) had experienced hunger in the previous 12 months, and 41 (13.8%) households were classified as food insecure with childhood hunger. Hunger was related to a variety of household characteristics and associated with several factors, including participation in food banks, dependence on family members and friends outside of the household for food, lacking reliable transportation, and not having a garden.

Position of the American Dietetic Association: domestic food and nutrition security.

In 2000, over 10% of United States (US) households, including more than 33 million people, experienced food insecurity. Food insecurity negatively affects the dietary intake and nutritional status of adults leading to poor health and increased risk for the development of chronic diseases. Food insecurity also negatively affects children's health, psychological and cognitive functioning, and their academic achievement. It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the US. Immediate and long-range interventions, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, are key to ending domestic food insecurity. Dietetics professionals can play a key role in ending food insecurity not only through competent and collaborative practice, but also through advocacy efforts at the local, state, regional, and national levels.