Purpose: Food insecurity remains a public health concern across the globe and despite access to greater resources, international data has demonstrated that high-income developed countries report an average food insecurity rate ranging from 8-20%. The purpose of this study is to identify potential factors influencing food insecurity and key coping strategies utilized among parents of children aged 0-6 in two high-income countries.

Methods: Semi-structured qualitative interviews were conducted with 40 low-income parents of children aged 0-6 in the United States (U.S.) and Australia (AUS), including pregnant women. Interviews included discussion of family and household dynamics around food procurement and preparation, strategies low-income parents employ to “make ends meet” and provide meals for their families, utilization of government and non-government assistance programs, and needs and recommendations to help support food insecure families. Interviews were audio recorded and transcribed verbatim. Inductive coding using QSR NVivo yielded emergent themes.

Results: Key themes that emerged included: food access and availability (e.g., neighborhood access, transportation, influences on food selection, food pantry use), food utilization (e.g., family food preference, pregnancy specific needs, culturally appropriate foods, kitchen facilities), financial implications (e.g., employment, government assistance time of month impact, competing expenses), resilience and coping (e.g., utilizing resources, budgeting skills, support from families and friends, nutrition knowledge and skill), Coronavirus Impacts (e.g., health, employment, child care), parenting and children (e.g., child awareness of food insecurity, generational poverty), stress and mental health, pregnancy impacts, and recommendations for local efforts to address food insecurity. Across these themes there were differences and similarities between U.S. and AUS interviewees which will be highlighted in the presentation.

Conclusions: A more unified global approach to addressing food insecurity is needed in order to translate best practices and design effective multi-country interventions. Comparing and contrasting the factors that influence food insecurity across the local context in the U.S. and AUS will help researchers better address policy, systems, and environmental components. The findings from this qualitative study can help to inform research on food insecurity across multiple high-income countries.

Purpose: This study aimed to characterize diet quality of low-income mothers and their children (8-12yr) and explore differences by food security status. Food insecurity is associated with low diet quality. Evidence suggests parents shield children from food insecurity; thus, we hypothesize that the correlation between diet quality among low-income mothers and children will differ by food security status.

Methods: Forty-six mother and child pairs (n=92) were recruited from a Federally Qualified Health Center to participate in a diabetes prevention program. Thirty-nine pairs completed baseline assessments. Dietary intake was assessed using two 24-hour dietary recall interviews (children) and the Southwest Food Frequency Questionnaire (mothers). Diet quality scores were calculated using the Healthy Eating Index (HEI-2015); higher scores (0-100) indicated better diet quality. Food security was assessed using the 2-item Hunger Vital Sign^TM; positive responses indicated food insecurity. T-tests were used to determine mean differences in diet quality by food security status. A two-sample test of equality of correlation coefficients determined whether the correlation between mother and child total diet quality differed by food security status.

Results: Mothers were 39.9±6.2 years, 87.2% Hispanic, 53.9% White. Children were 10.3±1.5 years, 46.1% female, 89.7% Hispanic, 56.0% White. Eighteen mother-child pairs were food insecure (46.2%). Mean diet quality score for mothers was 57.6±10.0; scores were lower among food insecure mothers compared to food secure (53.6±8.5 versus 61.0±10.2, p=0.02). Mean diet quality among children was 56.1±13.5 and did not differ by food security status. When stratified by food security status, only food secure mothers and children were significantly correlated (food secure r=0.60, p=0.004, food insecure r=0.13, p=0.60). However, the difference in the mother and child diet quality correlation coefficients by food security status was not statistically significant (p=0.09).

Conclusions: Significant correlations between food secure, but not food insecure, mothers and children were observed. These findings add to the growing evidence suggesting that mothers shield their children from the effects of food insecurity by forgoing their own intake of healthy foods. Future research with appropriately powered studies examining intra- and inter-household differences in food security, food choices and behaviors is needed.

Purpose: Food insecurity involves insufficient access to obtaining healthy food, and is highly prevalent among college students. While some emerging research has linked food insecurity to disordered eating behaviors (DEBs), no studies to our knowledge have explored the link between food insecurity and impulsivity as a possible behavioral mechanism explaining the relationship between food security (FS) status and DEBs. This study examined the extent to which impulsivity mediates the relationship between FS status and DEBs.

Methods: A convenience sample (n=423) of full-time undergraduate college students between the ages of 18-25 (78.8% female; 49.4% non-White), completed online surveys about their FS status. Validated measures of FS status (USDA Adult Food Security Survey Module), impulsivity (Kirby Delay Discounting Task), and DEBs (Eating Disorder Examination Questionnaire) were assessed. A multivariate ANCOVA mediation model using the product-of-coefficients examined whether impulsivity level mediated the relationship between FS status (food secure vs food insecure) and DEBs status (present vs. absent), while adjusting for sociodemographic characteristics.

Results:  Similar to other US-based estimates, the prevalence of food insecurity among college students in this sample was 27.0%. The prevalence of DEBs being present was 59.1%. Unstandardized beta coefficients derived from the mediation model indicated that impulsivity level significantly mediated (B=0.01, SE=0.006; 95% CI=0.001, 0.02) the relationship between FS status and DEBs status. FS status had a significant direct effect on impulsivity levels (B=0.03, SE=0.01; 95% CI=0.003, 0.06), and impulsivity levels had a significant direct effect on DEBs status (B=0.35, SE=0.16, 95% CI=0.04, 0.67). FS status had a significant direct effect on DEBs status (B=0.14, SE=0.05, 95% CI=0.03, 0.24). Additionally, the direct effect of FS status on DEBs status remained significant after adjusting for impulsivity level (B=0.13, SE=0.05; 95% CI=0.02, 0.23).

Conclusions: In this college student sample, impulsivity is a mediating behavioral mechanism in the relationship between FS status and DEBs status in this college student sample. These findings need to be replicated in other populations. Longitudinal research is needed to examine temporal effects of this relationship to better inform food insecurity interventions. 

Purpose: This study modified and tested the Healthy Diets Australian Standardised Affordability and Pricing (HD-ASAP) protocol, for use with low socioeconomic groups (SEGs) in Australia. The low SEG HD-ASAP aimed to investigate the cost, cost differential and affordability of habitual (based on dietary intake survey data) and recommended (healthy, more sustainable, more equitable) diets for low SEGs. Such evidence has been lacking to support policies and practices to improve food environments and help drive healthier diets in these groups.

Method: Components of the HD-ASAP protocol were modified to align with reported dietary intakes, household incomes, shopping habits and experiences of low SEGs in Australia.  Three reference households in the lowest income quintile were used for the modelling. Household A included two adults and two children; Household B included one adult and two children; and Household C included two older, retired adults. To test feasibility and utility of the modified protocol, food pricing data were collected from food outlets in one location. Models using brand name products and generic brands, reflecting a common coping strategy of low SEGs, were tested.

Results: Using brand name products, compared with habitual diets, recommended diets were 17% less expensive for Household A; 10% less expensive for Household B; and 4% less expensive for Household C.
When generic brand products were costed, compared with habitual diets, recommended diets were 10% less expensive for Household A; 2% more expensive for Household B; and equal cost for Household C.
In two households (A and B), reliance on unemployment benefits, resulted in both habitual and recommended diets being unaffordable (>30% of household income) unless generic brands were purchased.

Conclusions: The low SEG HD-ASAP protocol shows that recommended diets can be a similar cost or more expensive than habitual diets when generic products are chosen, contributing to perceptions that healthy food is unaffordable.  This study demonstrates the need for policies to increase the affordability of healthy diets by targeting both prices of healthy food and ensuring adequate household incomes amongst low SEGs specifically.

Purpose: Children with a lower socioeconomic position (SEP) tend to have poorer diet quality than their more advantaged counterparts. Evidence indicates that socioeconomic inequities in diet quality are stable or widening among adults, however, few studies have examined trends in the socioeconomic patterning of children’s diet quality. Given that SEP and dietary intake are modifiable, a better understanding of trends in socioeconomic inequities in diet quality among children can inform interventions to ensure all children have the same opportunity to attain their full health potential. This study quantified trends in inequities (i.e. absolute and relative gaps and gradients) in diet quality between 2004 and 2015 according to three indicators of SEP among children living in Canada. Methods: Data from children aged 2-17 years who participated in the cross-sectional, nationally representative Canadian Community Health Survey – Nutrition in 2004 (n=12,800) or 2015 (n=5,800) were analyzed.  SEP was classified based on total household income, parental educational attainment and neighborhood deprivation. Dietary intake data from interviewer-administered 24-hour recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using four indices: absolute gaps (between highest and lowest SEP), relative gaps, absolute gradients (slope index of inequality) and relative gradients (relative index of inequality). Multivariable linear regression models examined trends in HEI-2015 total and component scores between 2004 and 2015. Results: Absolute and relative gaps and gradients in total HEI-2015 scores were stable among children between 2004 and 2015 according to all three SEP indicators. There was evidence of widening absolute and relative gaps and of absolute gradients for several HEI-2015 components, including total protein foods, seafood and plant proteins, and sodium. Absolute and relative gaps declined for some components, namely added sugars and saturated fats. Conclusions: Absolute and relative gaps and gradients in total HEI-2015 scores were stable among children living in Canada between 2004 and 2015. There was some evidence of widening or declining inequities in HEI-2015 components. These analyses are internationally significant, as they are the first to assess absolute and relative gaps and gradients in diet quality among children using nationally representative data.

Purpose: Individuals with a lower socioeconomic position (SEP) have poorer health than their more advantaged counterparts. Psychosocial stress and diet quality have been shown to individually mediate associations between SEP and health, however studies have not yet investigated whether psychosocial stress and diet quality jointly mediate these associations. This is an important research question as stress-related unhealthy eating is often invoked as an explanation for health inequities, particularly among women, seemingly with no empirical justification. This study examined whether psychosocial stress and diet quality jointly mediate associations between SEP and self-rated health (SRH) in women and men. Methods: Adults living in Canada who participated in the 2018 or 2019 International Food Policy Study were included (n=5,645). Participants reported SEP using indicators that reflect materialist (educational attainment, perceived income adequacy) and psychosocial pathways (subjective social status) underlying health inequities. Participants also reported psychosocial stress, dietary intake (to estimate diet quality via the Healthy Eating Index-2015) and SRH. Structural equation modelling simultaneously modelled multiple pathways linking the three indicators of SEP (educational attainment, perceived income adequacy, subjective social status) with SRH mediated by psychosocial stress and diet quality, stratified by gender. Results: There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and SRH in women or men. Diet quality mediated associations between educational attainment and SRH in women and men, and between subjective social status and SRH in men.  Psychosocial stress mediated associations between perceived income adequacy and SRH in women and men, and between subjective social status and SRH in women. Conclusions: Although often invoked as an explanation for health inequities, stress-related poor diet quality did not mediate associations between SEP and SRH in women or men. However, psychosocial stress and diet quality individually mediated some of these associations, indicating that SEP was partially embodied via these pathways, with some differences by gender.