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Objective: To examine the relationship between household food insecurity and healthcare costs in children living in Ontario, Canada., Methods: We conducted a cross-sectional, population-based study using four cycles of the Canadian Community Health Survey (2007-2008, 2009-2010, 2011-2012, 2013-2014) linked with administrative health databases (ICES). We included Ontario children aged 1-17 years with a measure of household food insecurity (Household Food Security Survey Module) over the previous 12 months. Our primary outcome was the direct public-payer healthcare costs per child over the same time period (in Canadian dollars, standardized to year 2020). We used gamma-log-transformed generalized estimating equations accounting for the clustering of children to examine this relationship, and adjusted models for important sociodemographic covariates. As a secondary outcome, we examined healthcare usage of specific services and associated costs (e.g. visits to hospitals, surgeries)., Results: We found that adjusted healthcare costs were higher in children from food-insecure than from food-secure households ($676.79 [95% CI: $535.26, $855.74] vs. $563.98 [$457.00, $695.99], p = 0.047). Compared with children living in food-secure households, those in insecure households more often accessed hospitals, emergency departments, day surgeries, and home care, and used prescription medications. Children from food-secure households had higher usage of non-physician healthcare (e.g. optometry) and family physician rostering services., Conclusion: Even after adjusting for measurable social determinants of health, household food insecurity was associated with higher public-payer health services costs and utilization among children and youth. Efforts to mitigate food insecurity could lessen child healthcare needs, as well as associated costs to our healthcare systems., (© 2023. The Author(s) under exclusive license to The Canadian Public Health Association.)

Objectives: Household food insecurity is almost four times more prevalent among adolescents than among older adults in Canada, and it adversely affects their health. Our objective was to describe the sociodemographic and geographic patterning of household food insecurity among adolescents., Methods: Our analytic sample comprised all 12-17-year-old respondents to the 2017-2018 Canadian Community Health Survey with complete data on household food insecurity (n = 8416). We used bivariate and multivariable logistic regression models to identify respondent- and household-level sociodemographic characteristics associated with household food insecurity., Results: The prevalence of household food insecurity among adolescents was 20.7%. The adjusted odds of food insecurity were significantly elevated among adolescents who identified as Black or Indigenous (aOR 1.80), those living with a single parent (aOR 1.60), those living with a greater number of children ≤ 5 years (aOR 1.45) or 12-17 years (aOR 1.25), those in rented accommodation (aOR 1.98), those in households with only secondary school education (aOR 1.38), and those in households reliant on social assistance (aOR 2.03). Higher before-tax income was protective (aOR 0.99). In comparison with Ontario, the adjusted odds of food insecurity among adolescents were higher in Nunavut (aOR 6.77), Northwest Territories (aOR 2.11), and Alberta (aOR 1.48), and lower in Manitoba (aOR 0.66)., Conclusion: The markedly higher odds of exposure to household food insecurity among adolescents who are Black or Indigenous and those living in households characterized by markers of social and economic disadvantage highlight the need for more effective policy interventions to protect vulnerable families from this hardship., (© 2023. The Author(s).)

Objectives: The prevalence of household food insecurity in Newfoundland and Labrador (NL) fell sharply between 2007 and 2011, but it appears to have risen since then. Our objective was to compare the prevalence of food insecurity between 2011-2012 and 2017-2018 in relation to population socio-demographic characteristics., Methods: Our analytic sample comprised all NL households in the Canadian Community Health Survey (CCHS) cycles 2011-2012 and 2017-2018, n = 6800. We stratified the prevalence of household food insecurity for each cycle by socio-demographic characteristics and applied multivariable logistic regression models to determine food insecurity odds in 2017-2018 compared with 2011-2012 after controlling for socio-demographic covariates. Interactions of covariates with survey cycle were tested and models stratified when warranted., Results: The prevalence of food insecurity rose from 12.0% (95% CI 10.5, 13.6) in 2011-2012 to 14.7% (95% CI 13.1, 16.6) in 2017-2018. After adjusting for household socio-demographic variables, the odds of food insecurity was 1.49 (95% CI 1.27, 1.75) in 2017-2018. The prevalence of food insecurity had increased significantly among unattached individuals, renters, households with low educational attainment, and households with income above the Low Income Measure, with concomitant increases in the contribution of these groups to the total provincial prevalence of food insecurity in 2017-2018 compared with that in 2011-2012., Conclusion: The odds of food insecurity among NL households increased significantly from 2011-2012 to 2017-2018. Given the serious negative health implications of household food insecurity, the province should draw on the lessons from its earlier success in food insecurity reduction to reverse the current trend., (© 2021. The Author(s) under exclusive license to The Canadian Public Health Association.)

Objectives: To understand the differential vulnerability to household food insecurity of the Black population as compared with white counterparts in Canada., Methods: Using data for households with Black and white respondents in pooled Canadian Community Health Survey cycles from 2005 to 2014, the 18-question Household Food Security Survey Module was analyzed (N = 491,400). Bivariate and multivariate logistic and multinomial regression models were run using respondent's race, immigration status, and six well-established predictors of household food insecurity in the general population. Additional multivariable logistic regression models were run, with race interacted with each predictor individually to yield predicted probabilities., Results: The weighted prevalence of household food insecurity was 10.0% for white respondents and 28.4% for Black respondents. The odds of Black households being food-insecure as compared with white households fell from 3.56 (95% CI: 3.30-3.85) to 1.88 (95% CI: 1.70-2.08) with adjustment for household socio-demographic characteristics. In contrast with white households, there was relative homogeneity of risk of food insecurity among Black subgroups defined by immigration status, household composition, education, and province of residence. Homeownership was associated with lower probabilities of food insecurity for Black and white households, but the probability among Black owners was similar to that for white renters (14.7% vs. 14.3%). Black households had significantly higher predicted probabilities of food insecurity than their white counterparts across all main sources of household income except child benefits and social assistance., Conclusion: Being racialized as Black appears to be an overriding factor shaping vulnerability to food insecurity for the Black population in Canada. Future research and public policy on food insecurity should seriously consider the role of racism at the systemic and institutional levels., (© 2021. The Canadian Public Health Association.)

Objectives: To determine the prevalence and severity of household food insecurity and examine household material circumstances related to food insecurity in a sample of renter households in government-subsidized housing., Methods: Cross-sectional data from the 2010 Survey of Household Spending were used to determine the food insecurity status of 455 renter households living in the 10 provinces and receiving a government housing subsidy. Multivariable logistic regressions were conducted to examine the relationship between household characteristics describing material circumstances and food insecurity., Results: One in two households was food insecure. Marginal, moderate and severe food insecurity affected 9.0%, 23.3% and 18.5% of households respectively. Household economic resources, as captured with after-tax income, after-rent income, or total expenditure, had an independent, inverse relationship with food insecurity. Among the other characteristics examined, more adults or children in the household, presence of a member with disability, and receipt of social assistance increased the odds of food insecurity, but receipt of social assistance lost statistical significance when controlling for total expenditure. Presence of a senior in the household was independently associated with lower odds of food insecurity., Conclusion: Our findings suggest that more effective income-based interventions are needed to address food insecurity among low-income households receiving government housing subsidies. A better integration of housing and income-based policies is necessary to support household food security among government-subsidized renter households.

Objectives: To determine the extent to which Canadian adults' food preparation and cooking skills and use of home or community gardens relate to their household food insecurity status; and to compare the food shopping and cooking behaviours of adults in food-secure and food-insecure households., Methods: Data were drawn from two Rapid Response Modules appended to the Canadian Community Health Survey in 2012 and 2013. The analytic sample comprised 16,496 respondents 18 years and older. Multivariable logistic regression analyses were conducted to determine the association between food insecurity and adults' self-rated cooking abilities, food preparation skills score, use of gardens, food shopping behaviours, and cooking behaviours, while adjusting for socio-demographic characteristics., Results: Adults in food-insecure households did not differ significantly from others with respect to their food preparation skills or cooking ability, and neither variable predicted the odds of household food insecurity when socio-demographic characteristics were taken into account. Adults in food-insecure households were less likely to use a garden for food, but gardening was unrelated to the odds of food insecurity. Shopping with a budget was more common among adults in food-insecure households, but no other differences in food shopping behaviours were observed after adjustment for socio-demographic characteristics. Adults in food-insecure households were as likely as others to adjust recipes to make them healthier, but they had higher odds of adjusting recipes to reduce their fat content., Conclusion: Our findings suggest that household food insecurity in Canada is not a problem of insufficient food skills.

Objectives: The socio-demographic characteristics of food-insecure households in Canada have been well characterized, but there is little understanding of what drives the prevalence rates. This study was undertaken to estimate the prevalence of household food insecurity by census metropolitan area (CMA), compare prevalence rates within CMAs and within provinces over time, and assess the effect of local area economic characteristics on changes in CMA food insecurity rates., Methods: Data from the 2007-2012 annual components of the Canadian Community Health Survey were used to generate food insecurity rates for 33 CMAs and the corresponding nine provinces, and to compare changes in prevalence over time. Fixed-effects multiple linear regression analysis was applied to examine associations between changes in food insecurity and local area economic factors, considering peak unemployment rate, average number of Employment Insurance beneficiaries, vacancy rate, poverty rate and poverty gap., Results: Food insecurity rates ranged from 19.9% in Halifax to 9.0% in Quebec City in 2011-2012. Rates within and between CMAs were much more variable than provincial rates. Between 2007-2008 and 2011-2012, the prevalence increased significantly in Halifax, Montreal, Peterborough, Guelph, Calgary and Abbotsford, but decreased in Hamilton. Among the economic characteristics examined, only rising peak unemployment rates were linked to increases in food insecurity in CMAs., Conclusions: Our results suggest that policy initiatives to expand employment opportunities, improve the quality and stability of employment, and increase benefits for disadvantaged workers could reduce the prevalence of food insecurity within CMAs.

Objective: Growing recognition of the problem of household food insecurity in Canada has meant public health practitioners are looking for effective ways to ameliorate this problem in their communities. Community gardens, community kitchens, and food box programs can offer nutritious foods for comparably lower costs, however, the uptake and perceptions of these programs in populations at risk of food insecurity have not been evaluated. Building on a previous finding of low program participation among 485 families living in high-poverty neighbourhoods in Toronto, the objective of this study was to understand reasons for non-participation., Methods: One year after the baseline study, 371 families were interviewed a second time and were asked to provide their reasons for not participating in community gardens, community kitchens, or the Good Food Box program. Responses were analyzed by inductive content analysis., Results: At follow-up, only 12 families had participated in a community garden, 16 in a community kitchen, and 4 in the Good Food Box program. Reasons for non-participation grouped under two themes. First, families expressed that programs were not accessible because they lacked the knowledge of how or where to participate or because programs were not in their neighbourhoods. Second, programs lacked fit for families, as they were not suited to busy schedules, interests, or needs., Conclusions: This study provides unique perspective on participation in community food programs among food-insecure families and suggests that these programs may not be effective options for these families to improve their food access.

Objective: In 1998, the Canadian government mandated folic acid fortification of white flour and enriched grain products to lower the prevalence of neural tube defects. There is now growing concern over the potential harmful effects of too much folic acid on some segments of the population. Given that the actual amount of folate in Canadian foods is unknown, the objective of this study was to measure the folate content in selected fortified foods., Methods: Using data from the 2001 Food Expenditure Survey and the ACNielsen Company, 95 of the most commonly purchased folic acid-fortified foods in Canada were identified. Folate concentrations in these foods were determined using tri-enzyme digestion followed by microbiological assay. Analyzed values were compared to those in the Canadian Nutrient File (2007b, CNF) and to label values., Results: The analyzed folate content of foods was, on average, 151% +/- 63 of the CNF values. Analyzed values as a percent of CNF values ranged from 116% in the "rolls and buns" category to 188% in "ready-to-eat cereals". Analyzed values were higher than label values for "breads", "rolls and buns" and "ready-to-eat cereals" (141%, 118% and 237%, respectively [p < 0.05])., Conclusions: Ten years after folic acid fortification of the food supply, neither the CNF nor label values accurately reflect actual amounts of folate in foods. Further, overage differences by food category hinder the development of future strategies designed to strike the right balance between health benefits and risks; monitoring of fortified foods for their nutrient content is required.

Objectives: To identify socio-demographic factors associated with household food insecurity in the Ontario population., Methods: Using data from the Ontario Share File of the 2004 Canadian Community Health Survey, Cycle 2.2, multivariate logistic regression was applied to identify the socio-demographic characteristics of households most likely to report food insecurity., Results: Of the estimated 379,100 food-insecure households in Ontario in 2004, 55% were reliant on salaries or wages, 23% on social assistance, and 13% on pensions or seniors' benefits. The prevalence of food insecurity increased markedly as income adequacy declined, rising to 47% in the lowest category of income adequacy. Food insecurity was also more prevalent among tenant households and single-person and single-parent households. When all socio-demographic factors were taken into account, three potent socio-demographic correlates of household food insecurity in Ontario were identified: low income adequacy, social assistance as the main source of income, and not owning one's dwelling. Compared to households whose main source of income was salary or wages, the adjusted odds of experiencing food insecurity was 3.69 (95% CI: 2.33, 5.84) for households reliant on social assistance, but 0.44 (95% CI: 0.29, 0.67) for those reliant on pensions or seniors' benefits., Discussion: Our findings highlight the need for more adequate social assistance benefit levels, but also point to the need for better income supports for low-waged workers in Ontario so that they have sufficient financial resources to purchase the food they need.

Objectives: Responses to food insecurity in Canada have been dominated by community-based food initiatives, while little attention has been paid to potential policy directions to alleviate this problem. The purpose of this paper is to examine food security circumstances, participation in community food programs, and strategies employed in response to food shortages among a sample of low-income families residing in high-poverty Toronto neighbourhoods., Methods: Data from surveys conducted with 484 families and neighbourhood mapping were analyzed., Results: Two thirds of families were food insecure over the past 12 months and over one quarter were severely food insecure, indicative of food deprivation. Only one in five families used food banks in the past 12 months and the odds of use were higher among food-insecure families. One third of families participated in children's food programs but participation was not associated with household food security. One in 20 families used a community kitchen, and participation in community gardens was even lower. It was relatively common for families to delay payments of bills or rent and terminate services as a way to free up money for food and these behaviours were positively associated with food insecurity., Discussion: While documenting high rates of food insecurity, this research challenges the presumption that current community-based food initiatives are reaching those in need. Public health practitioners have a responsibility to critically examine the programs that they deliver to assess their relevance to food-insecure households and to advocate for policy reforms to ensure that low-income households have adequate resources for food.

Objective: To explain the low nutrient intakes of homeless youth in Toronto by looking at their usual food intake patterns and the food they obtained from charitable programs and their own purchases., Methods: Interviews were conducted with 261 homeless youth (149 male, 112 female), recruited from outdoor locations and drop-in centres in downtown Toronto. Drawing on data from two 24-hour dietary intake recalls, youths' usual food intakes were estimated and compared to Canada's Food Guide recommendations. The nutritional quality of youths' food intakes from charitable meal programs and food purchases was compared., Results: The mean usual food intakes for homeless males and females were well below current recommendations for all four food groups and below the usual intakes of adults, 19-30 years, in the general population. On a given day, youths' mean energy intakes were 1962 +/- 1394 kcal for females and 2163 +/- 1542 kcal for males, with more energy coming from "other foods" than any other food group. Regardless of whether they obtained food from charitable meal programs or purchased it for themselves, youths' mean intakes from the four food groups were very low and most youth consumed no whole grains or dark green or orange vegetables (i.e., foods recommended in Canada's Food Guide)., Conclusion: The low nutritional quality of youths' food intakes is consistent with the high prevalence of nutrient inadequacies previously documented in this sample. The existing food acquisition strategies of homeless youth appear to be insufficient for them to meet their nutritional needs.

Food insecurity, which has been recognized as an important determinant of health, is estimated to have affected almost one in ten Canadian households in 2004. Analyses of indicators of household food insecurity on several recent population health surveys have shed light on markers of vulnerability and the public health implications of this problem. However, the lack of detailed information on the economic circumstances of households and inconsistent measurement across surveys thwart attempts to develop a deeper understanding of problems of food insecurity. To better inform the development and evaluation of policies to address food insecurity among Canadian households, more effective monitoring is needed. This requires the consistent administration of a well-validated measure of food security on a population survey that routinely collects detailed information on the economic circumstances of households. Health professionals can contribute to the amelioration of problems of food insecurity in Canada by advocating for improved monitoring of the problem at a population level.

Objectives: This study assesses the affordability of a nutritious diet for households in Toronto that are supported by welfare., Methods: For three hypothetical households, welfare incomes were compared to the monthly costs for food, shelter, and other essential expenditures in Toronto., Results: If households lived in market rental accommodation, average monthly incomes were insufficient to cover expenses for the single-person household and two-parent family, and barely adequate for the single-parent family considered in this study. However, the single-parent family's actual income fell below expenses for six months of the year. For households with children, the relative inadequacy of welfare increased as children grew older. Living in rent-geared-to-income housing afforded substantial financial advantage, but the welfare income of single-person households was still insufficient to meet basic needs., Interpretation: These findings indicate discrepancies between welfare incomes and costs of basic needs, which may explain the vulnerability of welfare recipients to food insecurity.

Over the past two decades, the demand for charitable food assistance has steadily grown, and a massive ad hoc system of food banks has become established in Canada. To assess the food insecurity and nutritional vulnerability of one subgroup of food bank users, interviews were conducted with a sample of 153 women in families using emergency food relief programs in Metropolitan Toronto. Ninety percent reported household incomes which were less than two thirds of the 'poverty line', and 94% reported some degree of food insecurity over the previous 12 months. Seventy percent reported some level of absolute food deprivation, despite using food banks. The findings highlight the limited capacity of ad hoc, charitable food assistance programs to respond to problems of household food insecurity which arise in the context of severe and chronic poverty.

A brief survey was undertaken to assess the nature and severity of food scarcity experienced by a sample of 88 street youth in downtown Toronto, and to identify markers of vulnerability to food scarcity. Almost half of the youth reported experiencing involuntary hunger or food deprivation during the previous 30 days. Youth who were literally homeless (i.e., on the street or "squatting" in abandoned buildings) and those relying primarily on street-based activities for income appeared particularly vulnerable to food deprivation. Although limited in scope, the findings raise questions about the nutritional well-being of street youth and highlight the need for more effective interventions to address problems of poverty, hunger, and homelessness among Canadian youth.