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Household food insecurity is independently associated with adverse health outcomes among Canadians, but its association with overweight and obesity is poorly understood partly because of limited attention to confounding. This study assessed the relationship between food insecurity status and overweight/obesity in Canada. Cross-sectional data for individuals aged 2-64 years were drawn from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Overweight/obesity was defined using body mass index calculated with measured height and weight. Food insecurity status was assessed with the 18-item Household Food Security Survey Module. The relationship was examined among preschool children ( n  = 2007), girls ( n  = 5512), boys ( n  = 5507), women ( n  = 8317), and men ( n  = 7279) using propensity score weighted logistic regressions to control for confounding. Relative to their food-secure counterparts, girls in moderately food-insecure households (39.7% vs. 28.5%), boys in severely food-insecure households (54.4% vs. 35.0%), and women in moderately and severely food-insecure households (58.9% and 73.1% vs. 50.7%) had higher overweight/obesity prevalence; men in moderately food-insecure households had a lower prevalence (48.9% vs. 66.3%). With propensity score weighting, no association existed between food insecurity and overweight/obesity among preschool children, girls, boys, or men. For women, moderate (adjusted odds ratio (AOR): 1.61; 95% confidence interval (95%CI): 1.06-2.47) and severe (AOR: 2.33; 95%CI: 1.22-4.44) food insecurity was positively associated with overweight/obesity; the association was strongest for severe food insecurity and obesity (AOR: 3.38; 95%CI: 1.60-7.16). Additional research is needed to better understand the nature of the relationship among women. Problems of food insecurity and overweight/obesity among Canadian children and men should not be conflated in public health interventions., Competing Interests: The authors declare there are no competing interest.

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.)

Objective: To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP) and to examine associations between household food insecurity and breastfeeding practices to 6 months., Design: Cohort investigation pooling data from two studies which administered the 18-item Household Food Security Survey Module at 6 months postpartum and collected prospective infant feeding data at 2 weeks and 2, 4 and 6 months. Household food insecurity was classified as none, marginal, moderate or severe. Logistic regression analyses were performed to assess predictors of household food insecurity and associations between household food security (any and severity) and continued and exclusive breastfeeding., Setting: Three Toronto sites of the CPNP, a federal initiative targeting socially and/or economically vulnerable women., Participants: 316 birth mothers registered prenatally in the CPNP from 2017 to 2020., Results: Household food insecurity at 6 months postpartum was highly prevalent (44 %), including 11 % in the severe category. Risk of household food insecurity varied by CPNP site ( P < 0·001) and was higher among multiparous participants (OR 2·08; 95 % CI 1·28, 3·39). There was no association between the prevalence or severity of food insecurity and continued or exclusive breastfeeding to 6 months postpartum in the adjusted analyses., Conclusions: Household food insecurity affected nearly half of this cohort of women accessing the CPNP. Further research is needed on household food insecurity across the national CPNP and other similar programmes, with consideration of the implications for programme design, service delivery and policy responses.

Introduction: Food insecurity-the inadequate access to food due to financial constraints-affects 1 in 6 households in Canada, with serious health implications. Family benefit programs supplementing income have shown potential in mitigating the risk of food insecurity, but there is little understanding of their protective effects. The authors aimed to estimate the impacts of the additional Canada Child Benefit provided to families with children aged <6 years on household food insecurity., Methods: The authors sampled 28,435 households receiving Canada Child Benefit with children aged <8 years from the Canadian Income Survey 2018-2020 fielded in 2019-2021 and analyzed in 2022. Households without children aged <6 years were 1:1 propensity-score matched to those with children aged <6 years, who received up to $1,068 in additional Canada Child Benefit per child annually. The authors compared the 2 groups' 12-month food insecurity likelihood after matching. Subsample analyses were performed by household income, housing tenure, and household type., Results: Receipt of the additional Canada Child Benefit ($724 on average) was associated with 2.89 (95% CI=1.35, 4.42) percentage points lower probability of experiencing food insecurity among recipients with children aged <6 years (from 24.30% to 21.42%). The association was similar across socioeconomic subgroups and significant among all but high-income earners and mortgage-free homeowners., Conclusions: The authors found plausibly causal evidence that the more generous Canada Child Benefit for Canadian families with young children reduces their probability of food insecurity. Increasing benefits for economically disadvantaged households, characterized by low incomes, single parenthood, and renting (versus owning), may improve the program's efficiency and equity in supporting families' food security., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

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).)

Background: The results of several recent campus-based studies indicate that over half of post-secondary students in Canada are food insecure, but the vulnerability of this group has not been considered in research on predictors of food insecurity in the Canadian population. Our objectives were to (1) compare the prevalence of food insecurity among post-secondary students and non-students of similar age; (2) examine the relationship between student status and food insecurity among young adults while accounting for sociodemographic characteristics; and (3) identify the sociodemographic characteristics associated with food insecurity among post-secondary students., Methods: Using data from the 2018 Canadian Income Survey, we identified 11,679 young adults aged 19-30 and classified them into full-time postsecondary students, part-time post-secondary students, and non-students. Food insecurity over the past 12 months was assessed with the 10-item Adult Scale from the Household Food Security Survey Module. Multivariable logistic regression analyses were used to estimate the odds of food insecurity by student status while accounting for sociodemographic characteristics, and to identify sociodemographic characteristics predictive of food insecurity among post-secondary students., Results: The prevalence of food insecurity was 15.0% among full-time postsecondary students, 16.2% among part-time students, and 19.2% among non-students. After adjusting for sociodemographic factors, full-time postsecondary students had 39% lower odds of being food insecure as compared to non-students (aOR 0.61, 95% CI 0.50-0.76). Among postsecondary students, those with children (aOR 1.93, 95%CI 1.10-3.40), those living in rented accommodation (aOR 1.60, 95%CI 1.08-2.37), and those in families reliant on social assistance (aOR 4.32, 95%CI 1.60-11.69) had higher adjusted odds of food insecurity, but having at least a Bachelor's degree appeared protective (aOR: 0.63, 95% CI 0.41-0.95). Every $5000 increase in adjusted after-tax family income was also associated with lower adjusted odds of food insecurity (aOR 0.88, 95%CI 0.84-0.92) among post-secondary students., Conclusions: In this large, population-representative sample, we found that young adults who did not attend post-secondary school were more vulnerable to food insecurity, particularly severe food insecurity, than full-time post-secondary students in Canada. Our results highlight the need for research to identify effective policy interventions to reduce food insecurity among young, working-age adults in general., (© 2023. The Author(s).)

Competing Interests: The authors have no conflicts of interest.

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.)

Background: Food insecurity, inadequate access to food due to financial constraints, is a major public health issue in the United States and Canada, where the same 18-item questionnaire is used to monitor food insecurity. Researchers often assume that findings on food insecurity from the 2 countries are comparable with each other, but there are between-country differences in how food insecurity status is determined., Objectives: We aimed to compare the distribution of household food insecurity in the Canadian population applying the US and Canadian classification schemes. We also examined the extent to which associations between food insecurity and adults' health differ under the 2 schemes., Methods: We used the population-representative Canadian Community Health Survey 2005-2017 linked to administrative health records. Food insecurity was measured by the Household Food Security Survey Module. Adults 18 y and older with valid food insecurity status were included from all jurisdictions except Quebec (n = 403,200). We cross-tabulated food insecurity status classified by the US and Canadian schemes. We also fitted logistic regressions on self-reported and objective health measures adjusting for confounders., Results: Applying the Canadian classification scheme, 7.7% of households were food insecure; the number fell to 6.0% with the US scheme. Associations between food insecurity status and health measures were mostly similar across classification schemes, although the associations between food insecurity and self-reported health were slightly larger if the US scheme was applied. Marginal food security/insecurity was associated with worse health measures irrespective of the classification scheme. United States-Canada discordance in classification of marginal food security/insecurity had a limited effect on health prediction., Conclusions: United States-Canada differences in classification affected the apparent distribution of household food insecurity but not the associations between food insecurity and measures of adult health. Marginal food security/insecurity should be set apart from the food-secure group for trend monitoring and health research., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Objective: To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status., Design: Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age., Setting: Ten provinces in Canada., Participants: Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909., Results: Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children., Conclusions: With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

Food insecurity, inadequate access to food due to financial constraints, affects 17.3% of Canadian children, with serious health repercussions. Capitalizing on the geo-temporal variation in social policies and economic environments across Canadian provinces between 2005 and 2018, we examined the association between provincial policies and economic environments and likelihood of experiencing food insecurity among households with children. Drawn from 13 years of the Canadian Community Health Survey, our sample comprised 123,300 households with below-median income with children under 18 in the ten provinces. We applied generalized ordered logit models on the overall sample and subsamples stratified by Low-Income Measure (LIM). Higher minimum wage, lower income tax, and lower unemployment rate were associated with lower odds of food insecurity in the overall sample. A hypothetical one-dollar increase in minimum wage was associated with 0.8 to 1.0-percentage-point decrease in probability of food insecurity. The probability of food security increased by 1.2 to 1.6 percentage points following a one-percentage-point drop in bottom-bracket income tax rate. One-percentage-point lower unemployment rate corresponded to 0.6 to 0.8-percentage-point higher probability of food security. Higher welfare income and lower housing price predicted lower likelihood of severe food insecurity in the below-LIM subsample. Higher sales tax and median wage predicted higher likelihood of food insecurity among above-LIM households. Income support policies, favorable labor market conditions, and affordable living costs were all related to reduced food insecurity among Canadian households with children. Policies that increase minimum wage, reduce taxes, and create jobs may help alleviate food insecurity., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The prevalence of food insecurity among adults over 65 in Canada is less than half of that among adults approaching 65, possibly due in part to the public pension universally disbursed from the age of 65. Given research associating food insecurity with higher risk of premature mortality, our objective was to determine the likelihood that food-insecure adults with incomes below the national median would live past 65 to collect the public pension., Methods: We linked respondents of the Canadian Community Health Survey 2005-15 to the death records from the Canadian Vital Statistics Database 2005-17. We assessed household food insecurity status through a validated 18-item questionnaire for 50,780 adults aged 52-64 at interview and with household income below the national median. We traced their vital status up to the age of 65. We fitted Cox proportional hazard models to compare hazard of all-cause mortality before 65 by food insecurity status while adjusting for individual demographic attributes, baseline health, and household socioeconomic characteristics. We also stratified the sample by income and analyzed the subsamples with income above and below the Low Income Measure separately., Results: Marginal, moderate, and severe food insecurity were experienced by 4.1, 7.3, and 4.5% of the sampled adults, respectively. The crude mortality rate was 49 per 10,000 person-years for food-secure adults and 86, 98, and 150 per 10,000 person-years for their marginally, moderately, and severely food-insecure counterparts, respectively. For the full sample and low-income subsample, respectively, severe food insecurity was associated with 1.24 (95% CI: 1.06, 1.45) and 1.28 (95% CI: 1.07, 1.52) times higher hazard of dying before 65 relative to food security. No association was found between food insecurity and mortality in the higher-income subsample., Conclusions: Severely food-insecure adults approaching retirement age were more likely to die before collecting public pensions that might attenuate their food insecurity. Policymakers need to acknowledge the challenges to food security and health faced by working-age adults and provide them with adequate assistance to ensure healthy ageing into retirement.

Background: Eradicating food insecurity is necessary for achieving global health goals. Liberal trade policies might increase food supplies but how these policies influence individual-level food insecurity remains uncertain. We aimed to assess the association between liberal trade policies and food insecurity at the individual level, and whether this association varies across country-income and household-income groups., Methods: For this observational analysis, we combined individual-level data from the Food and Agricultural Organization of the UN with a country-level trade policy index from the Konjunkturforschungsstelle Swiss Economic Institute. We examined the association between a country's trade policy score and the probability of individuals reporting moderate-severe or severe food insecurity using regression models and algorithmic weighting procedures. We controlled for multiple covariates, including gross domestic product, democratisation level, and population size. Additionally, we examined heterogeneity by country and household income., Results: Our sample comprised 460 102 individuals in 132 countries for the period of 2014-17. Liberal trade policy was not significantly associated with moderate-severe or severe food insecurity after covariate adjustment. However, among households in high-income countries with incomes higher than US$25 430 per person per year (adjusted for purchasing power parity), a unit increase in the trade policy index (more liberal) corresponded to a 0·07% (95% CI -0·10 to -0·04) reduction in the predicted probability of reporting moderate-severe food insecurity. Among households in the lowest income decile (<$450 per person per year) in low-income countries, a unit increase in the trade policy index was associated with a 0·35% (0·06 to 0·60) increase in the predicted probability of reporting moderate-severe food insecurity., Interpretation: The relationship between liberal trade policy and food insecurity varied across countries and households. Liberal trade policy was predominantly associated with lower food insecurity in high-income countries but corresponded to increased food insecurity among the world's poorest households in low-income countries., Funding: Joseph Rowntree Foundation, Economic and Social Research Council., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Food insecurity predicts poorer health, yet how it relates to health care use and costs in Canada remains understudied. Linking data from the Canadian Community Health Survey to hospital records and health care expenditure data, we examined the association of food insecurity with acute care hospitalization, same-day surgery, and acute care costs among Canadian adults, adjusting for sociodemographic characteristics. Compared with fully food-secure adults, marginally, moderately, and severely food-insecure adults presented 26 percent, 41 percent, and 69 percent higher odds of acute care admission and 15 percent, 15 percent, and 24 percent higher odds of having same-day surgery, respectively. Conditional on acute care admission, food-insecure adults stayed from 1.48 to 2.08 more days in the hospital and incurred $400-$565 more per person-year in acute care costs than their food-secure counterparts, with this excess cost representing 4.4 percent of total acute care costs. Programs reducing food insecurity, such as child benefits and public pensions, and policies enhancing access to outpatient care may lower health care use and costs.

Background: Food insecurity affects 1 in 8 households in Canada, with serious health consequences. We investigated the association between household food insecurity and all-cause and cause-specific mortality., Methods: We assessed the food insecurity status of Canadian adults using the Canadian Community Health Survey 2005-2017 and identified premature deaths among the survey respondents using the Canadian Vital Statistics Database 2005-2017. Applying Cox survival analyses to the linked data sets, we compared adults' all-cause and cause-specific mortality hazard by their household food insecurity status., Results: Of the 510 010 adults sampled (3 390 500 person-years), 25 460 died prematurely by 2017. Death rates of food-secure adults and their counterparts experiencing marginal, moderate and severe food insecurity were 736, 752, 834 and 1124 per 100 000 person-years, respectively. The adjusted hazard ratios (HRs) of all-cause premature mortality for marginal, moderate and severe food insecurity were 1.10 (95% confidence interval [CI] 1.03-1.18), 1.11 (95% CI 1.05-1.18) and 1.37 (95% CI 1.27-1.47), respectively. Among adults who died prematurely, those experiencing severe food insecurity died on average 9 years earlier than their food-secure counterparts (age 59.5 v. 68.9 yr). Severe food insecurity was consistently associated with higher mortality across all causes of death except cancers; the association was particularly pronounced for infectious-parasitic diseases (adjusted HR 2.24, 95% CI 1.42-3.55), unintentional injuries (adjusted HR 2.69, 95% CI 2.04-3.56) and suicides (adjusted HR 2.21, 95% CI 1.50-3.24)., Interpretation: Canadian adults from food-insecure households were more likely to die prematurely than their food-secure counterparts. Efforts to reduce premature mortality should consider food insecurity as a relevant social determinant., Competing Interests: Competing interests: None declared., (© 2020 Joule Inc. or its licensors.)

Background: Household food insecurity is a potent marker of material deprivation with adverse health consequences. Studies have repeatedly found a strong, independent relationship between owning a home and lower vulnerability to food insecurity in Canada and elsewhere, but the reasons for this relationship are poorly understood. We aimed to examine the influence of housing asset, housing debt and housing expenditure on the relationship between homeownership status and food insecurity in Canada., Methods: Cross-sectional data on food insecurity, housing tenure and expenditures, home value, income and sociodemographic characteristics were derived from the 2010 Survey of Household Spending, a population-based survey. Multivariable logistic regression models were conducted to estimate odds ratios of food insecurity among households of all incomes (n = 10,815) and those with lower incomes (n = 5547)., Results: Food insecurity prevalence was highest among market renters (28.5%), followed by homeowners with a mortgage (11.6%) and mortgage-free homeowners (4.3%). Homeowners with a mortgage (OR: 0.51, 95% CI: 0.39-0.68) and those without a mortgage (OR: 0.23, 95% CI: 0.16-0.35) had substantially lower adjusted odds of food insecurity than market renters, and accounting for the burden of housing cost had minimal impact on the association. Mortgage-free homeowners had lower adjusted odds ratios of food insecurity compared to homeowners with a mortgage, but differences in the burden of housing cost fully accounted for the association. When stratifying homeowners based on presence of mortgage and housing asset level, the adjusted odds ratios of food insecurity for market renters were not significant when compared to mortgage holders with low housing asset. Mortgage-free owners with higher housing asset were least vulnerable to food insecurity (adjusted OR: 0.18, 95% CI: 0.11-0.27)., Conclusions: Substantial disparities in food insecurity exist between households with different homeownership status and housing asset level. Housing policies that support homeownership while ensuring affordable mortgages may be important to mitigate food insecurity, but policy actions are required to address renters' high vulnerability to food insecurity.

Food insecurity is a pervasive public health problem in high income countries, disproportionately affecting households with children. Though it has been strongly linked with socioeconomic status and investments in social protection programs, less is known about its sensitivity to specific policy interventions, particularly among families. We implemented a difference-in-difference (DID) design to assess whether Canadian households with children experienced reductions in food insecurity compared to those without following the roll-out of a new country-wide income transfer program: the Canada Child Benefit (CCB). Data were derived from the 2015-2018 cycles of Canadian Community Health Survey. We used multinomial logistic regressions to test the association between CCB and food insecurity among three samples: households reporting any income (N = 41,455), the median income or less (N = 18,191) and the Low Income Measure (LIM) or less (N = 7579). The prevalence and severity of food insecurity increased with economic vulnerability, and were both consistently higher among households with children. However, they also experienced significantly greater drops in the likelihood of experiencing severe food insecurity following CCB; most dramatically among those reporting the LIM or less (DID: -4.7%, 95% CI: -8.6, -0.7). These results suggest that CCB disproportionately benefited families most susceptible to food insecurity. Furthermore, our findings also indicate that food insecurity may be impacted by even modest changes to economic circumstance, speaking to the potential of income transfers to help people meet their basic needs., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Studies indicate an association between disability and higher rates of household food insecurity (HFI). Geographic variation in this relationship has not been explored despite the potential influence of economic and political contexts, including costs of living and disability social assistance. This study examines the association between mobility impairment and HFI within and across Canada considering the possible role of population composition, contextual, and collective influences. Using data from 217,094 adults from the 2007/08, 2009/10, 2013/14, and 2015/16 Canadian Community Health Survey, multivariate logistic regression models examined associations between mobility impairment and HFI controlling for socio-demographic factors and geography of residence (i.e., province, region, and urban/rural status). Subsequent analysis of 14,353 surveyed adults with mobility impairments was conducted to examine geographic and socio-demographic factors associated with HFI in this population. Adults with mobility impairments had elevated odds of HFI of 3.85 (95% CI: 3.49-4.24), when adjusting for age, sex, and geography of residence and 2.11 (95% CI: 1.89-2.35) adjusting for additional socio-demographic characteristics. Across Canada, mobility impaired adults experienced greater odds of HFI. Significantly lower odds of HFI were found for mobility impaired adults living in Newfoundland, Alberta, and Saskatchewan compared to Ontario when adjusting for age and sex, and in Quebec when controlling for additional socio-demographic factors. Socioeconomic factors and age accounted for most variation in HFI in this population, suggesting the importance of poverty reduction strategies that reduce vulnerability to HFI across the population., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Rising food bank use in the past decade in the UK raises questions about whether food insecurity has increased. Using the 2016 Food and You survey, we describe the magnitude and severity of the problem, examine characteristics associated with severity of food insecurity, and examine how vulnerability has changed among low-income households by comparing 2016 data to the 2004 Low Income Diet and Nutrition Survey., Methods: The Food and You survey is a representative survey of adults living in England, Wales, and Northern Ireland (n=3118). Generalised ordered logistic regression models were used to examine how socioeconomic characteristics related to severity of food insecurity. Coarsened exact matching was used to match respondents to respondents in the 2004 survey. Logistic regression models were used to examine if food insecurity rose between survey years., Results: 20.7% (95% CI 18.7% to 22.8%) of adults experienced food insecurity in 2016, and 2.72% (95% CI 2.07% to 3.58%) were severely food insecure. Younger age, non-white ethnicity, low education, disability, unemployment, and low income were all associated with food insecurity, but only the latter three characteristics were associated with severe food insecurity. Controlling for socioeconomic variables, the probability of low-income adults being food insecure rose from 27.7% (95% CI 24.8% to 30.6 %) in 2004 to 45.8% (95% CI 41.6% to 49.9%) in 2016. The rise was most pronounced for people with disabilities., Conclusions: Food insecurity affects economically deprived groups in the UK, but unemployment, disability and low income are characteristics specifically associated with severe food insecurity. Vulnerability to food insecurity has worsened among low-income adults since 2004, particularly among those with disabilities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Household food insecurity, a measure of income-related problems of food access, is a pressing public health problem in Canada's North, especially in Nunavut. We aimed to assess the impact of Nutrition North Canada, a food retail subsidy intended to improve food access and affordability in isolated communities, on household food insecurity in Nunavut., Methods: Using data from 3250 Nunavut households sampled in the annual components of the Canadian Community Health Survey (2007 to 2016), we conducted interrupted time series regression analyses to determine whether the introduction of Nutrition North Canada was associated with changes in the rates of self-reported food insecurity, according to a validated instrument. We used propensity score weighting to control for several sociodemographic characteristics associated with food insecurity., Results: Food insecurity affected 33.1% of households in 2010 (the year before the launch of Nutrition North Canada), 39.4% of households in 2011 (the year of the launch) and 46.6% of households in 2014 (the year after full implementation). After controlling for several covariates, we found the rate of food insecurity increased by 13.2 percentage points (95% confidence interval [CI] 1.7 to 24.7) after the full implementation of the subsidy program, and the increase in food insecurity first occurred in 2011 (9.6 percentage points, 95% CI 2.7 to 16.4), the year Nutrition North Canada was launched., Interpretation: Food insecurity was a pervasive problem in Nunavut before Nutrition North Canada, but it has become even more prevalent since the program was implemented. Given the important health consequences of food insecurity, more effective initiatives to address food insecurity in Canada's North are urgently needed., Competing Interests: Competing interests: Andrée-Anne Fafard St-Germain and Valerie Tarasuk report grants from the Canadian Institutes of Health Research (CIHR) during the conduct of the study. No other competing interests were declared., (© 2019 Joule Inc. or its licensors.)

Background: Household food insecurity is a potent social determinant of health and health care costs in Canada, but understanding of the social and economic conditions that underlie households' vulnerability to food insecurity is limited., Methods: Data from the 2011-12 Canadian Community Health Survey were used to determine predictors of household food insecurity among a nationally-representative sample of 120,909 households. Household food insecurity over the past 12 months was assessed using the 18-item Household Food Security Survey Module. Households were classified as food secure or marginally, moderately, or severely food insecure based on the number of affirmative responses. Multivariable binary and multinomial logistic regression analyses were used to determine geographic and socio-demographic predictors of presence and severity of household food insecurity., Results: The prevalence of household food insecurity ranged from 11.8% in Ontario to 41.0% in Nunavut. After adjusting for socio-demographic factors, households' odds of food insecurity were lower in Quebec and higher in the Maritimes, territories, and Alberta, compared to Ontario. The adjusted odds of food insecurity were also higher among households reliant on social assistance, Employment Insurance or workers' compensation, those without a university degree, those with children under 18, unattached individuals, renters, and those with an Aboriginal respondent. Higher income, immigration, and reliance on seniors' income sources were protective against food insecurity. Living in Nunavut and relying on social assistance were the strongest predictors of severe food insecurity, but severity was also associated with income, education, household composition, Aboriginal status, immigration status, and place of residence. The relation between income and food insecurity status was graded, with every $1000 increase in income associated with 2% lower odds of marginal food insecurity, 4% lower odds of moderate food insecurity, and 5% lower odds of severe food insecurity., Conclusions: The probability of household food insecurity in Canada and the severity of the experience depends on a household's province or territory of residence, income, main source of income, housing tenure, education, Aboriginal status, and household structure. Our findings highlight the intersection of household food insecurity with public policy decisions in Canada and the disproportionate burden of food insecurity among Indigenous peoples.

Background: Food insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries., Methods: We use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as "food secure", "marginally food insecure", "moderately food insecure", or "severely food insecure". We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health., Results: Using a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93)., Interpretation: These findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality., Competing Interests: All authors had financial support from the Canadian Institutes of Health Research for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. The authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objective: Food insecurity is a potent determinant of health and indicator of material deprivation in many affluent countries. Food insecurity is associated with compromises in food and housing expenditures, but how it relates to other expenditures is unknown. The present study described households' resource allocation over a 12-month period by food insecurity status., Design: Expenditure data from the 2010 Survey of Household Spending were aggregated into four categories (basic needs, other necessities, discretionary, investments/assets) and ten sub-categories (food, clothing, housing, transportation, household/personal care, health/education, leisure, miscellaneous, personal insurance/pension, durables/assets). A four-level food insecurity status was created using the adult-specific items of the Household Food Security Survey Module. Mean dollars spent and budget share by food insecurity status were estimated with generalized linear models adjusted first for household size and composition, and subsequently for after-tax income quartiles., Setting: Canada., Subjects: Population-based sample of households from the ten provinces (n 9050)., Results: Food-secure households had higher mean total expenditures than marginally, moderately and severely food-insecure households (P-trend <0·0001). As severity of food insecurity increased, households spent less on all categories and sub-categories, except transportation, but they allocated a larger budget share to basic needs and smaller shares to discretionary spending and investments/assets. The downward trends for dollars spent on basic needs and other necessities became non-significant after accounting for income, but the upward trend in the budget shares for basic needs persisted., Conclusions: The spending patterns of food-insecure households suggest that they prioritized essential needs above all else.

Background: Qualitative studies have suggested that food insecurity adversely affects infant feeding practices. We aimed to determine how household food insecurity relates to breastfeeding initiation, duration of exclusive breastfeeding and vitamin D supplementation of breastfed infants in Canada., Methods: We studied 10 450 women who had completed the Maternal Experiences - Breastfeeding Module and the Household Food Security Survey Module of the Canadian Community Health Survey (2005-2014) and who had given birth in the year of or year before their interview. We used multivariable Cox proportional hazards models and logistic regression to examine the relation between food insecurity and infant feeding practices, adjusting for sociodemographic characteristics, maternal mood disorders and diabetes mellitus., Results: Overall, 17% of the women reported household food insecurity, of whom 8.6% had moderate food insecurity and 2.9% had severe food insecurity (weighted percentages). After adjustment for sociodemographic factors, women with food insecurity were no less likely than others to initiate breastfeeding or provide vitamin D supplementation to their infants. Half of the women with food insecurity ceased exclusive breastfeeding by 2 months, whereas most of those with food security persisted with breastfeeding for 4 months or more. Relative to women with food security, those with marginal, moderate and severe food insecurity had significantly lower odds of exclusive breastfeeding to 4 months, but only women with moderate food insecurity had lower odds of exclusive breastfeeding to 6 months, independent of sociodemographic characteristics (odds ratio 0.60, 95% confidence interval 0.39-0.92). Adjustment for maternal mood disorder or diabetes slightly attenuated these relationships., Interpretation: Mothers caring for infants in food-insecure households attempted to follow infant feeding recommendations, but were less able than women with food security to sustain exclusive breastfeeding. Our findings highlight the need for more effective interventions to support food-insecure families with newborns., Competing Interests: Competing interests: None declared., (© 2018 Joule Inc. or its licensors.)

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.

As concerns about food insecurity in high income countries grow, there is a need to better understand the impact of social policy decisions on this problem. In Canada, provincial government actions are particularly important because food insecurity places substantial burden on provincial health care budgets. This study was undertaken to describe the socio-demographic and temporal patterning of food insecurity in British Columbia (BC) from 2005 to 2012 and determine the impact of BC's one-time increase in social assistance and introduction of the Rental Assistance Program (RAP) on food insecurity rates among target groups. Using data from the Canadian Community Health Surveys, logistic regression analyses were conducted to identify trends and assess changes in food insecurity among subgroups differentiated by main source of income and housing tenure. Models were run against overall food insecurity, moderate and severe food insecurity, and severe food insecurity to explore whether the impact of policy changes differed by severity of food insecurity. Overall food insecurity rose significantly among households in BC between 2005 and 2012. Following the increase in social assistance benefits, overall food insecurity and moderate and severe food insecurity declined among households on social assistance, but severe food insecurity remained unchanged. We could discern no effect of the RAP on any measure of food insecurity among renter households. Our findings indicate the sensitivity of food insecurity among social assistance recipients to improvements in income and highlight the importance of examining severity of food insecurity when assessing the effects of policy interventions., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

While there has recently been considerable research and public investment in strategies to address homelessness in Canada, food charity remains the primary response to hunger, with little evaluation of current efforts and no initiatives to develop more effective approaches. Using data from a 2010-2011 survey of charitable food assistance in five Canadian cities, this study was undertaken to describe charitable meal provisioning in each city and to compare the relative roles of emergency programs and multi-service agencies and their capacity to meet food needs. Most meals were provided by multi-service agencies, but like emergency programs, these agencies were heavily dependent on donations and they were more likely than emergency programs to report constraints and service interruptions because demands exceeded available supplies. Our findings underscore the resource-limited and often fragile nature of charitable meal programs in Canada and highlight the need for more effective models of response to problems of hunger.

Background: Household food insecurity, a measure of income-related problems of food access, is growing in Canada and is tightly linked to poorer health status. We examined the association between household food insecurity status and annual health care costs., Methods: We obtained data for 67 033 people aged 18-64 years in Ontario who participated in the Canadian Community Health Survey in 2005, 2007/08 or 2009/10 to assess their household food insecurity status in the 12 months before the survey interview. We linked these data with administrative health care data to determine individuals' direct health care costs during the same 12-month period., Results: Total health care costs and mean costs for inpatient hospital care, emergency department visits, physician services, same-day surgeries, home care services and prescription drugs covered by the Ontario Drug Benefit Program rose systematically with increasing severity of household food insecurity. Compared with total annual health care costs in food-secure households, adjusted annual costs were 16% ($235) higher in households with marginal food insecurity (95% confidence interval [CI] 10%-23% [$141-$334]), 32% ($455) higher in households with moderate food insecurity (95% CI 25%-39% [$361-$553]) and 76% ($1092) higher in households with severe food insecurity (95% CI 65%-88% [$934-$1260]). When costs of prescription drugs covered by the Ontario Drug Benefit Program were included, the adjusted annual costs were 23% higher in households with marginal food insecurity (95% CI 16%-31%), 49% higher in those with moderate food insecurity (95% CI 41%-57%) and 121% higher in those with severe food insecurity (95% CI 107%-136%)., Interpretation: Household food insecurity was a robust predictor of health care utilization and costs incurred by working-age adults, independent of other social determinants of health. Policy interventions at the provincial or federal level designed to reduce household food insecurity could offset considerable public expenditures in health care., (© 2015 Canadian Medical Association or its licensors.)

Background: The most recent statistics indicate that the prevalence of food insecurity in the United States is double that in Canada, but the extent to which the nutrition implications of this problem differ between the countries is not known., Objective: This study was undertaken to compare adequacy of nutrient intakes in relation to household food insecurity among youth and adults in Canada and the United States., Methods: Data from comparable nationally representative surveys, the 2004 Canadian Community Health Survey and the 2003-2006 NHANES, were used to estimate prevalences of inadequate intakes of vitamins A and C, folate, calcium, magnesium, and zinc among youth and adults in food-secure and food-insecure households. Potential differences in the composition of the populations between the 2 countries were addressed by using standardization, and analyses also accounted for participation in food and nutrition assistance programs in the United States., Results: Larger gaps in the prevalences of inadequate intakes between those in food-secure and food-insecure households were observed in Canada than in the United States for calcium and magnesium. For calcium, the prevalences of inadequate intakes among those in food-secure and food-insecure households in Canada were 50% and 66%, respectively, compared with 50% and 51%, respectively, in the United States. For magnesium, the prevalences of inadequate intakes in Canada were 39% and 60% among those in food-secure and food-insecure households, respectively, compared with 60% and 61%, respectively, in the United States. These findings were largely unchanged after we accounted for participation in food and nutrition assistance programs in the United States., Conclusions: This study suggests that household food insecurity is a stronger marker of nutritional vulnerability in Canada than in the United States. The results highlight the need for research to elucidate the effects of domestic policies affecting factors such as food prices and fortification on the nutritional manifestations of food insecurity., (© 2015 American Society for Nutrition.)

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.

Background: Food banks have emerged in response to growing food insecurity among low-income groups in many affluent nations, but their ability to manage this problem is questionable. In Canada, in the absence of public programs and policy interventions, food banks are the only source of immediate assistance for households struggling to meet food needs, but there are many indications that this response is insufficient. The purpose of this study was to examine the factors that facilitate and limit food bank operations in five Canadian cities and appraise the potential of these initiatives to meet food needs., Methods: An inventory of charitable food provisioning in Halifax, Quebec City, Toronto, Edmonton, and Victoria, Canada was conducted in 2010. Of the 517 agencies that participated in a telephone survey of their operations, 340 were running grocery programs. Multivariate regression analyses were conducted to determine the association between program characteristics, volume of service, and indicators of strain in food banks' abilities to consistently achieve the standards of assistance they had established., Results: Extensive, well-established food bank activities were charted in each city, with the numbers of people assisted ranging from 7,111 in Halifax to 90,141 in Toronto per month. Seventy-two percent of agencies indicated that clients needed more food than they provided. The number of people served by any one agency in the course of a month was positively associated with the proportion of food distributed that came from donations (beta 0.0143, SE 0.0024, p 0.0041) and the number of volunteers working in the agency (beta 0.0630, SE 0.0159, p 0.0167). Food banks only achieved equilibrium between supply and demand when they contained demand through restrictions on client access. When access to assistance was less restricted, the odds of food banks running out of food and invoking measures to ration remaining supplies and restrict access rose significantly., Conclusions: Despite their extensive history, food banks in Canada remain dependent on donations and volunteers, with available resources quickly exhausted in the face of agencies' efforts to more fully meet clients' needs. Food banks have limited capacity to respond to the needs of those who seek assistance.

Analyses of cross-sectional population survey data in Canada and the United States have indicated that household food insecurity is associated with poorer self-rated health and multiple chronic conditions. The causal inference has been that household food insecurity contributes to poorer health, but there has been little consideration of how adults' health status may relate to households' vulnerability to food insecurity. Our objectives were to examine how the presence of an adult with one or more chronic physical or mental health conditions affects the odds of a household being food insecure and how the chronic ill-health of an adult within a food-insecure household affects the severity of that household's food insecurity. Using household- and respondent-level data available for 77,053 adults aged 18-64 y from the 2007-2008 Canadian Community Health Survey, we applied logistic regression analyses, controlling for household sociodemographic characteristics, to examine the association between health and household food insecurity. Most chronic conditions increased the odds of household food insecurity independent of household sociodemographic characteristics. Compared with adults with no chronic condition, the odds of household food insecurity were 1.43 (95% CI: 1.28, 1.59), 1.86 (95% CI: 1.62, 2.14), and 3.44 (95% CI: 3.02, 3.93) for adults with 1, 2, and 3 or more chronic conditions, respectively. Among food-insecure households, adults with multiple chronic conditions had higher odds of severe household food insecurity than adults with no chronic condition. The chronic ill-health of adults may render their households more vulnerable to food insecurity. This has important practice implications for health professionals who can identify and assist those at risk, but it also suggests that appropriate chronic disease management may reduce the prevalence and severity of food insecurity.

Cross-sectional studies have established a relationship between poverty and food insecurity, but little is known about the acute changes within households that lead to changes in food insecurity. This study examined how changes in income, employment status, and receipt of welfare related to change in severity of food insecurity during 1 y among low-income families. In 2005-2007, 501 families living in market and subsidized rental housing were recruited through door-to-door sampling in high-poverty neighborhoods in Toronto. One year later, families were re-interviewed. The final longitudinal analytic sample included 331 families. Within-household change in income, employment, and welfare receipt were examined in relation to change in severity of food insecurity. Severity was denoted by the aggregate raw score on the Household Food Security Survey Module (HFSSM). Analyses were stratified by housing subsidy status owing to differences in characteristics between households. Food insecurity was a persistent problem among families; 68% were food insecure at both interviews. Severity was dynamic, however, as 73.4% answered more or fewer questions affirmatively on the HFFSM between baseline and follow-up. Among market-rent families, a $2000 gain in income during the year and gain of full-time employment were associated with a 0.29 and 1.33 decrease in raw score, respectively (P < 0.01). This study suggests that improvements in income and employment are related to improvements in families' experiences of food insecurity, highlighting the potential for income- and employment-based policy interventions to affect the severity of household food insecurity for low-income families.

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.

Household food insecurity is a pervasive problem in North America with serious health consequences. While affordable housing has been cited as a potential policy approach to improve food insecurity, the relationship between conventional notions of housing affordability and household food security is not well understood. Furthermore, the influence of housing subsidies, a key policy intervention aimed at improving housing affordability in Western countries, on food insecurity is unclear. We undertook a cross-sectional survey of 473 families in market rental (n = 222) and subsidized (n = 251) housing in high-poverty urban neighborhoods to examine the influence of housing circumstances on household food security. Food insecurity, evident among two thirds of families, was inversely associated with income and after-shelter income. Food insecurity prevalence did not differ between families in market and subsidized housing, but families in subsidized housing had lower odds of food insecurity than those on a waiting list for such housing. Market families with housing costs that consumed more than 30% of their income had increased odds of food insecurity. Rent arrears were also positively associated with food insecurity. Compromises in housing quality were evident, perhaps reflecting the impact of financial constraints on multiple basic needs as well as conscious efforts to contain housing costs to free up resources for food and other needs. Our findings raise questions about current housing affordability norms and highlight the need for a review of housing interventions to ensure that they enable families to maintain adequate housing and obtain their other basic needs.

Objective: Although the sociodemographic characteristics of food-insecure households have been well documented, there has been little examination of neighbourhood characteristics in relation to this problem. In the present study we examined the association between household food security and neighbourhood features including geographic food access and perceived neighbourhood social capital., Design: Cross-sectional survey and mapping of discount supermarkets and community food programmes., Setting: Twelve high-poverty neighbourhoods in Toronto, Ontario, Canada., Subjects: Respondents from 484 low-income families who had children and who lived in rental accommodations., Results: Food insecurity was pervasive, affecting two-thirds of families with about a quarter categorized as severely food insecure, indicative of food deprivation. Food insecurity was associated with household factors including income and income source. However, food security did not appear to be mitigated by proximity to food retail or community food programmes, and high rates of food insecurity were observed in neighbourhoods with good geographic food access. While low perceived neighbourhood social capital was associated with higher odds of food insecurity, this effect did not persist once we accounted for household sociodemographic factors., Conclusions: Our findings raise questions about the extent to which neighbourhood-level interventions to improve factors such as food access or social cohesion can mitigate problems of food insecurity that are rooted in resource constraints. In contrast, the results reinforce the importance of household-level characteristics and highlight the need for interventions to address the financial constraints that underlie problems of food insecurity.

Objective: To describe homeless youths' experiences of food insecurity and examine the relation between chronic food deprivation and food acquisition practices., Design: A cross-sectional survey of homeless youths was conducted in 2003 to assess their nutritional vulnerability and describe their food acquisition practices., Setting: Toronto, Canada., Subjects: Two hundred and sixty-one youths, aged 16-24 years, who had spent ten or more of the past thirty nights sleeping in a temporary shelter, public space or friend's place, because they had no place of their own. Most participant recruitment (70%) occurred outdoors, but 30% were recruited in drop-in centres., Results: Over the past 30 d, 28% of males and 43% of females experienced chronic food deprivation (i.e. reduced food intake for > or =10 d), and 32% of females and 48% of males reported problems obtaining water to drink. Most youths routinely obtained meals at charitable programmes and panhandled for money for food, and many routinely stole food or ate day-old food obtained from restaurants. In contrast, eating food discarded by others and postponing debt payments were strategies of desperation, more common among youths experiencing chronic food deprivation. Additionally, for males, deliberately seeking the company of friends, relatives or acquaintances to obtain food, and for females, borrowing money or trading sex for food, were associated with chronic food deprivation., Conclusions: The pervasiveness and severity of food insecurity experienced by the youths and their desperate means of food acquisition highlight the need for more effective responses to the plight of homeless youths in Canadian cities.

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.

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.

Household food insecurity constrains food selection, but whether the dietary compromises associated with this problem heighten the risk of nutrient inadequacies is unclear. The objectives of this study were to examine the relationship between household food security status and adults' and children's dietary intakes and to estimate the prevalence of nutrient inadequacies among adults and children, differentiating by household food security status. We analyzed 24-h recall and household food security data for persons aged 1-70 y from the 2004 Canadian Community Health Survey (cycle 2.2). The relationship between adults' and children's nutrient and food intakes and household food security status was assessed using regression analysis. Estimates of the prevalence of inadequate nutrient intakes by food security status and age/sex group were calculated using probability assessment methods. Poorer dietary intakes were observed among adolescents and adults in food-insecure households and many of the differences by food security status persisted after accounting for potential confounders in multivariate analyses. Higher estimated prevalences of nutrient inadequacy were apparent among adolescents and adults in food-insecure households, with the differences most marked for protein, vitamin A, thiamin, riboflavin, vitamin B-6, folate, vitamin B-12, magnesium, phosphorus, and zinc. Among children, few differences in dietary intakes by household food security status were apparent and there was little indication of nutrient inadequacy. This study indicates that for adults and, to some degree, adolescents, food insecurity is associated with inadequate nutrient intakes. These findings highlight the need for concerted public policy responses to ameliorate household food insecurity.

Objectives: A number of studies have pointed to the pressure that housing costs can exert on the resources available for food. The objectives of the present study were to characterise the relationship between the proportion of income absorbed by housing and the adequacy of household food expenditures across the Canadian population and within income quintiles; and to elucidate the impact of receipt of a housing subsidy on adequacy of food expenditures among low-income tenant households., Design: The 2001 Survey of Household Spending, conducted by Statistics Canada, was a national cross-sectional survey that collected detailed information on expenditures on goods and services. The adequacy of food spending was assessed in relation to the cost of a basic nutritious diet., Setting: Canada., Subjects: The person with primary responsibility for financial maintenance from 15 535 households from all provinces and territories., Results: As the proportion of income allocated to housing increased, food spending adequacy declined significantly among households in the three lowest income quintiles. After accounting for household income and composition, receipt of a housing subsidy was associated with an improvement in adequacy of food spending among low-income tenant households, but still mean food spending fell below the cost of a basic nutritious diet even among subsidised households., Conclusions: This study indicates that housing costs compromise the food access of some low-income households and speaks to the need to re-examine policies related to housing affordability and income adequacy.

Objective: To characterize the relationships between selected socio-demographic factors and food selection among Canadian households., Design: A secondary analysis of data from the 1996 Family Food Expenditure survey was conducted (n=10,924). Household food purchases were classified into one of the five food groups from Canada's Food Guide to Healthy Eating. Parametric and non-parametric modelling techniques were employed to analyse the effects of household size, composition, income and education on the proportion of income spent on each food group and the quantity purchased from each food group., Results: Household size, composition, income and education together explained 21-29% of the variation in food purchasing. Households with older adults spent a greater share of their income on vegetables and fruit (P<0.0001), whereas households with children purchased greater quantities of milk products (P<0.0001). Higher income was associated with purchasing more of all food groups (P<0.0001), but the associations were nonlinear, with the strongest effects at lower income levels. Households where the reference person had a university degree purchased significantly more vegetables and fruit, and less meat and alternatives and 'other' foods (P<0.0001), relative to households with the lowest education level., Conclusions: Household socio-demographic characteristics have a strong influence on food purchasing, with the purchase of vegetables and fruit being particularly sensitive. Results reinforce concerns about constraints on food purchasing among lower income households. Furthermore, the differential effects of income and education on food choice need to be considered in the design of public health interventions aimed at altering dietary behaviour.

A secondary analysis of data from a study of nutritional vulnerability among 153 women in families seeking charitable food assistance was undertaken to estimate the extent and nutritional significance of at-home food preparation activity for these women. At-home food preparation was estimated from women's reported food intakes from three 24-hour recalls. The relationships between food preparation and energy and nutrient intake, food intake, and 30-day household food security status were characterized. Almost all participants (97%) consumed foods prepared from scratch at least once during the three days of observation; 57% did so each day. Both the frequency and complexity of at-home food preparation were positively related to women's energy and nutrient intakes and their consumption of fruits and vegetables, grain products, and meat and alternates. The intakes by women in households with food insecurity with hunger reflected less complex food preparation but no less preparation from scratch than women in households where hunger was not evident, raising questions about the extent to which food skills can protect very poor families from food insecurity and hunger. Our findings indicate the need for nutrition professionals to become effective advocates for policy reforms to lessen economic constraints on poor households.

Objectives: To compare food expenditure patterns between low-income households and higher- income households in the Canadian population, and to examine the relationship between food expenditure patterns and the presence or absence of housing payments among low-income households., Design: Secondary data analysis of the 1996 Family Food Expenditure Survey conducted by Statistics Canada., Setting: Sociodemographic data and 1-week food expenditure data for 9793 households were analysed., Subjects: Data were collected from a nationally representative sample drawn through stratified multistage sampling. Low-income households were identified using Statistics Canada's Low Income Measures., Results: Total food expenditures, expenditures at stores and expenditures in restaurants were lower among low-income households compared with other households. Despite allocating a slightly greater proportion of their food dollars to milk products, low-income households purchased significantly fewer servings of these foods. They also purchased fewer servings of fruits and vegetables than did higher-income households. The effect of low income on milk product purchases persisted when the sample was stratified by education and expenditure patterns were examined in relation to income within strata. Among low-income households, the purchase of milk products and meat and alternatives was significantly lower for households that had to pay rents or mortgages than for those without housing payments., Conclusions: Our findings indicate that, among Canadian households, access to milk products and fruits and vegetables may be constrained in the context of low incomes. This study highlights the need for greater attention to the affordability of nutritious foods for low-income groups.

Community-based charitable food assistance programs have recently been established in several affluent nations to distribute public and corporate food donations to 'the needy'. In Canada, food banks comprise the primary response to hunger and food insecurity, but problems of unmet food need persist. We conducted an ethnographic study of food bank work in southern Ontario to examine the functioning of these extra-governmental, charitable food assistance programs in relation to problems of unmet need. Our results suggest that the limited, variable and largely uncontrollable supply of food donations shaped the ways in which food assistance was defined and the practices that governed its distribution. Workers framed the food assistance as a supplement or form of acute hunger relief, but generally acknowledged that the food given was insufficient to fully meet the needs of those who sought assistance. In response to supply limitations, workers restricted both the frequency with which individual clients could receive assistance and the amount and selection of food that they received on any one occasion. Food giving was essentially a symbolic gesture, with the distribution of food assistance dissociated from clients' needs and unmet needs rendered invisible. We conclude that, structurally, food banks lack the capacity to respond to the food needs of those who seek assistance. Moreover, the invisibility of unmet need in food banks provides little impetus for either community groups or government to seek solutions to this problem.

Current knowledge about food insecurity in North America is largely based on research with low-income households. Much less is known about the food experiences of homeless people, a group who are particularly vulnerable to food insecurity. This study explored the food experiences of street youth, one of the fastest growing segments of the homeless population in Canada. To gain an in-depth understanding of food insecurity within the context of daily life, ethnographic research was undertaken with street youth at one inner-city drop-in centre in Toronto, Canada. Results of this study reveal that street youth's access to food was precarious amidst the instability and chaos of street life. The day-to-day lives of the street youth encountered in this study were characterized by a constant struggle to find safe, secure shelter, generate income, and obtain sufficient food. In this context, food was a precious commodity. Food access was inextricably linked to and contingent upon conditions of health, shelter, and income. Food access was precarious since everyday food sources purchased food and charitable food assistance were ultimately insecure. "Squeegeeing" (washing car windows), the primary source of income for youth in the study, was dependent on the weather, political and public will, and youth's physical health, and thus did not generate enough money to continuously meet basic food needs. Charitable food assistance was considered poor quality and was associated with food sickness. The often unsavoury atmosphere of charitable food programmes, their locations, capacity, and idiosyncratic rules, policies, and hours of operation also affected access. Findings from this study extend the current understanding of food insecurity to homeless youth and offer insight into current responses to hunger and homelessness.