Purpose: Due to the coexistence of food insecurity and diet-related health disparities and diseases, nutrition security recently emerged in the United States as a more common and viable construct compared to food security. While encompassing the ideas of food security, nutrition security is more comprehensive in promoting “consistent and equitable access to healthy, safe, and affordable foods that promote optimal health and well-being,” as defined by the United States Department of Agriculture. Nutrition patterns of US individuals continue to fall short of dietary recommendations, and yet a clear conceptual framework of what it means to be nutrition secure does not currently exist. To address this gap in the literature and initiate the development of such a framework, a meta-ethnography approach was used to review 58 relevant qualitative studies on nutrition security.

Methods: The seven-step process for a meta-ethnography was used to collect information from the most relevant, highest quality 58 qualitative papers of 6,831 screened. Inclusion criteria was set as follows: US based studies with qualitative research methods, publication in 2013 or later, and a diverse sample of primarily adults who did not have specified chronic conditions nor were exclusively older adults. Two research team members independently read and extracted data from each paper. The data extraction information was then combined, and two investigators generated themes to determine critical constructs of nutrition security.

Results: The final conceptual framework includes two primary constructs, 16 secondary constructs, and 51 tertiary constructs of nutrition security. The two primary constructs are environmental circumstances and psychosocial functioning. The secondary constructs within environmental circumstances include availability, accessibility, affordability, acceptability, and accommodation related to healthy food, the importance of cooking appliances, federal and charitable nutrition assistance programs, stability, management of chronic stress, and pace of life. Psychosocial functioning includes secondary constructs of cognitive coping, obligement, financial adjustments, agency, self-efficacy, and social support.

Conclusions: A more comprehensive understanding of nutrition security and the proposed conceptual framework will help guide the development of an improved measure of nutrition security in order to facilitate more targeted interventions that aid in better diet quality and overall health.

Purpose

Nutrition insecurity is a major public health issue globally that disproportionately impacts vulnerable populations. Nutrition security encompasses food security and additionally emphasizes healthfulness and equitable access. However, while the global community has coalesced around two common food security measures (Household Food Security Survey Module and Food Insecurity Experience Scale), there is no standard measure for nutrition security.

The authors created and conducted initial validation testing of a 4-item nutrition security scale in 2022 (Household Nutrition Security Measure). The measure was made freely publicly available to enable other researchers to use and test the tool in various contexts and applications. The purpose of the current study was to conduct additional testing using Rasch modeling to build on the exploratory factor analysis and classical test theory approaches employed in the initial testing study.

Methods

Rasch modeling was used in a secondary analysis of cross-sectional survey data. Respondents were recruited from food pantries and free health clinics across five American states (CA, FL, MD, NC, WA).

Results

Respondents (n=432) were aged 45.1 years (SD=14.6), 74% women, and 77% experiencing poverty. Infit (0.76-1.30) and outfit (0.74-1.30) supported item model-fit and usefulness for measurement. The person separation index (1.81) and person reliability coefficient (0.77) were above acceptable thresholds, indicating the measure’s ability to separate respondents into strata. Differential Item Functioning (DIF), a metric assessing item-level bias, was assessed for gender, race, education, age, and poverty status. No DIF was detected (all effect sizes <0.17). Item difficulty (threshold parameters) ranged from -3.24 – 2.96, indicating good coverage across levels of the latent trait. These metrics, as a whole, support the validity of this tool to measure the latent trait in this sample.

Conclusions

While the concept of nutrition security is complex, brief measurement and screening is crucial for feasibility in real world settings, both in the United States and globally. Additional testing in this study supports the validity of the Household Nutrition Security Measure. However, more testing in different contexts (e.g., developing countries) is needed. Additionally, there is a need to develop more comprehensive measures to better explore nutrition security and inform behavioral intervention approaches.

Purpose: Nutrition-related diseases are a major public health concern, marked by substantial health inequity and costs in the United States and globally. While progress has been made in addressing food security issues, the focus has been on ensuring access to sufficient calories, rather than prioritizing access to nutritious foods. Recognizing the importance of quality over quantity, a construct of "nutrition security" is emerging, transforming healthcare, public health, and policy. This construct goes beyond food security and is especially relevant to underserved communities. The Gretchen Swanson Center for Nutrition (GSCN) has developed a four-item Household Nutrition Security Measure. Three questions address household food consumption and its impact on health and well-being; while, the fourth question assesses dietary diversity. The screening tool has demonstrated initial validity, but further testing in different contexts is needed for refinement and validation. This symposium section will share research using this tool to enhance our understanding of nutrition security in diverse settings.

Methods: The symposium will present data on two different studies, each contributing to a deeper understanding of nutrition security: 1) a secondary data analysis study of the initial data collected by the GSCN (n=486); and 2) a primary data collection study with food pantry clients (n=60).

Results: The secondary analysis study examined the relationship between nutrition security, food security, and diabetes in adults and found a significant association between higher nutrition security scores and reduced odds of diabetes (AOR= 0.59; 95% CI: 0.44, 0.79; p-value<0.001), particularly among non-SNAP participants. The study also demonstrated that food insecurity, in isolation, was not statistically associated with diabetes. The symposium's primary data collection study with food pantry clients promises further insights into this critical issue. Further analysis is underway; results will be ready for presentation at the upcoming annual meeting.

Conclusions: The current studies emphasize the relevance and importance of nutrition security in addressing nutrition-related diseases, particularly among vulnerable populations. Prioritizing access to nourishing foods, not just calories, can make a significant impact on public health, emphasizing the need for further research in this domain.