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Refugees experience elevated risk of chronic disease post-resettlement. Understanding contributors to refugee knowledge of the connection between food and health may help promote healthful resettlement. A random survey was conducted with Cambodian refugee and asylee women in Lowell, MA (n = 160). Knowledge of the connection between health and food categories (meat with fat, soda, fast food, high-sodium sauces, salt, vegetables, fruit, and whole grains) was assessed. High food security, literacy, and having participated in nutrition education were related to higher knowledge. Approaches to refugee health should include improving food security and should be tailored to varied literacy levels. [ABSTRACT FROM AUTHOR]

Objectives. We investigated Cambodian refugee women's past food experiences and the relationship between those experiences and current food beliefs, dietary practices, and weight status. Methods. Focus group participants (n=11) described past food experiences and current health-related food beliefs and behaviors. We randomly selected survey participants (n=133) from a comprehensive list of Cambodian households in Lowell, Massachusetts. We collected height, weight, 24-hour dietary recall, food beliefs, past food experience, and demographic information. We constructed a measure of past food deprivation from focus group and survey responses. We analyzed data with multivariate logistic and linear regression models. Results. Participants experienced severe past food deprivation and insecurity. Those with higher past food-deprivation scores were more likely to currently report eating meat with fat (odds ratio [OR]=1.14 for every point increase on the 9-to-27-point food-deprivation measure), and to be overweight or obese by Centers for Disease Control and Prevention (OR=1.28) and World Health Organization (OR=1.18) standards. Conclusions. Refugees who experienced extensive food deprivation or insecurity may be more likely to engage in unhealthful eating practices and to be overweight or obese than are those who experienced less-extreme food deprivation or insecurity. (Am J Public Health. 2010;100:1930-1937. doi: 10.2105/AJPH.2009.175869)

This paper hypothesizes that there is a common 'core' to the household food insecurity experience that goes beyond insufficient food quantity and that transcends culture. The paper for the first time employs an exploratory approach to identify cross-cultural commonalities of the food insecurity experience as captured in 22 scales and related ethnographies derived from 15 different countries. The constant comparative method was used to code elements of the food insecurity experience expressed in the ethnographies and to regroup them into domains and subdomains. This typology was then applied to ascertain which experiential domains and subdomains were measured (or not) across all 22 studies. Survey data from 11 of the studies were then analyzed to assess similarities in the relative frequency with which culturally diverse households responded to questionnaire items related to these common domains/subdomains. The analysis confirmed that insufficient food quantity, inadequate food quality, and uncertainty and worry about food were a significant part of the food insecurity experience in all sampled cultures; concerns about social unacceptability emerged in all ethnographic accounts. Several subdomains were identified, such as concern over food safety and meal pattern disruption, with potentially important consequences for physical and psychological well-being. The comparative survey data showed that the relative frequency at which populations responded to domain-related questionnaire items was similar across all but a few cultures. Future food insecurity assessments should consider these core domains and subdomains as the starting point for measures that can generate rich information to inform food security policies and programs. KEY WORDS: * food insecurity * evaluation * meta-analysis * qualitative * indicators

This paper compares a qualitative and a quantitative (Rasch) method of item assessment for developing the content of a food insecurity scale for Bangladesh. Data are derived from the Bangladesh Food Insecurity Measurement and Validation Study, in which researchers collected 2 rounds of ethnographic information and 3 rounds of conventional household survey data between 2001 and 2003. The qualitative method of scale development relied on content experts and respondents themselves to evaluate household food insecurity items generated through ethnographic research. The quantitative method applied the Rasch model to assess the fit of the same items using representative survey data. The Rasch model was then used to test for differential item functioning (DIF) across diverse demographic and geographic subgroups. The qualitative assessment flagged and discarded 10 items, leaving 13. The Rasch assessment of infit and outfit flagged 3 items, and the Rasch DIF test discarded another 10 items, leaving a total of 10 items in the Rasch-derived scale. The 2 scales contained 8 of the same items. The qualitatively and quantitatively derived scales were highly correlated (r = 0.96, P < 0.01), and the 2 methods located 90% of households in the same food insecurity tercile. This convergence lends added confidence to the use of either scale for identifying food-insecure households in different regions of Bangladesh. Multiple methods should continue to be applied in a systematic and transparent way to lend additional credence to the results when they converge and to pinpoint directions for further clarification where they do not. KEY WORDS: * food insecurity * mixed-methods * Bangladesh * qualitative methods * quantitative methods

Food insecurity is a daily reality for hundreds of millions of people around the world. Although its most extreme manifestations are often obvious, many other households facing constraints in their access to food are less identifiable. Operational agencies lack a method for differentiating households at varying degrees of food insecurity in order to target and evaluate their interventions. This chapter provides an overview of a set of papers associated with a research initiative that seeks to identify more precise, yet simple, measures of household food insecurity. The overview highlights three main conceptual developments associated with practical approaches to measuring constraints in access to food: 1) a shift from using measures of food availability and utilization to measuring 'inadequate access'; 2) a shift from a focus on objective to subjective measures; and 3) a growing emphasis on fundamental measurement as opposed to reliance on distal, proxy measures. Further research is needed regarding 1) how well measures of household food insecurity designed for chronically food-insecure contexts capture the processes leading to, and experience of, acute food insecurity, 2) the impact of short-term shocks, such as major floods or earthquake, on household behaviors that determine responses to food security questions, 3) better measurement of the interaction between severity and frequency of household food insecurity behaviors, and 4) the determination of whether an individual's response to survey questions can be representative of the food insecurity experiences of all members of the household. KEY WORDS: * food insecurity * risk. vulnerability * measurement

Nutrition programs in developing countries benefit from standard monitoring and evaluation. Data collected on input and output during a nutritional project permit valid conclusions without distortion from other influences. Planning and implementation is followed by monthly impact measurements and a final evaluation. The benefits of lower mortality rates and improved economic conditions translate into a better life for everyone.

Female control of household resources is often associated with consumption preferences which favor basic needs and child welfare. Using data from the Dominican Republic, this study tests differences in spending patterns, consumption preferences, and child nutritional (anthropometric) status according to four definitions of female household headship. Female-headed households (FHH) allocate the same amount or less of their budgets to food than male-headed households (MHH), in absolute and proportional terms. FHH consume higher quality, more expensive and protein-dense foods (more animal products; less of beans and rice) than MHH. Average caloric adequacy per adult-equivalent is equal or lower in FHH, but children's anthropometric status is the same or higher; it is significantly higher in low-income FHH, possibly due to intrahousehold allocation of food which favors children.

Different definitions of female household headship have different implications for the economic status and welfare of members of female headed households (FHH). Using data from the Dominican Republic, this study compares four definitions of FHH: self-definition; no adult males (18-60) present; female earns over 50% of earned or of total income. The definitions are associated, but each defines a different group. Half of self-defined FHH contain adult males; half of those in which the woman is the major earner are self-defined FHH. In the Dominican Republic, female headship by any definition is not associated with lower income per capita, but sources of income are quite different: FHH are more dependent on transfers and girls than wages; FHH defined by earnings are of higher income on average. Demographic composition of FHH is significantly different from male headed households MHH.

An analysis of data on poverty threshold since the 1980s, obtained from the Central Bureau, reveals that the poverty rates are higher among the elderly than the nonelderly. The nutrient requirements of the elderly are not lower and the elderly spend a higher proportion of their budgets on food and other necessities.

A national representative household survey of food consumption, income, and expenditure was conducted in the Dominican Republic in 1986 by Tufts University School of Nutrition in cooperation with USAID Office of Nutrition (1: Rogers B. L. and Swindale A. Determinants of Food Consumption in the Dominican Republic. USAID/S & T/Nutrition, Washington, DC, 1988). Out of 1440 families surveyed 706 had children under 6 years of age. Anthropometric indicators of height and weight were collected for all 1251 children in the sample in a follow-up study conducted from December 1986 to January 1987 by Tufts with USAID/Santo Domingo Mission funding. Anthropometric measurements were converted to standard deviation scores using NCHS standards; nutritional status was thus measured by height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). Earnings in families with children having males as heads-of-household were roughly one-third greater than in those with females as household head; total income was also greater in these families, though not significantly. More calories and protein per adult equivalent were available in male-headed families as well. In spite of this superior economic and dietary situation, there was a trend throughout the entire sample for children of female-headed households to be taller and heavier for their age than those of two parent homes; all three anthropometric measures showed differences in the same direction. In the lowest expenditure quartile, WAZ and WHZ were significantly greater for children in female-headed households than their counterparts in male-headed households (WAZ: P = 0.01, WHZ: P = 0.00). This finding remained significant even when controlling for the mother's employment outside the home. Multivariate regression analysis of children from households in the lowest quartile revealed a significant positive association between the percentage of household earnings from women and nutritional status, particularly HAZ. The percentage of income from women was highly significant, and its beta coefficient was high compared with other significant variables included in the model. This positive effect remained strong even when controlling for total income, mother's schooling, and such child characteristics as birthweight, birth order and age. It is concluded that at low income levels in the Dominican Republic, children from female-headed households are at least as well nourished as children living in male-headed households of the same income class; this may be explained in part, by female-generated income.

To determine whether or not parental perceptions about the School Breakfast Program (SBP) are associated with SBP participation among low-income children, the attitudes of low-income parents toward a newly-implemented SBP in Lawrence, Massachusetts were surveyed. Self-administered surveys were sent home to the parents of 1086 children; response rate was 70%. Sixty percent of respondents reported that their child ate breakfast at school. Children were significantly more likely to be participants than non-participants if they were Hispanic as opposed to white, non-Hispanic, if they shared in the decision as to where they would eat breakfast, and if they were eligible for free meals as opposed to reduced-price meals. Parents of participants were significantly more likely than parents of non-participants to feel the SBP would save them time or energy and family food money, and that it was good for children to eat with their classmates. As might be expected, participants' parents were significantly less likely to feel that children should only eat breakfast at home with the family. Additional research is needed to address factors that prevent low-income children who wish to participate in an SBP from doing so. In addition to student and family characteristics, future research should investigate school characteristics, program operations, the effectiveness of program promotion, and the role of nutrition education.

The purpose of this study was to test an ecological model designed to identify social and environmental factors that encourage local produce buying. Pre- and postintervention surveys in June and September 1997 measured local produce purchasing and factors identified by the model. At three mid-sized worksites in a rural Maine community, the response rate was 68% (135 employees) preintervention and 61% (124) postintervention. For 6 weeks, workers were given the opportunity to order local produce at work; to see, taste, and read about the produce; and to see coworkers sample and buy it. Associations were examined between increased purchases of locally grown produce outside the workplace and ordering at work, proportion of friends who ordered, degree of satisfaction with orders ascribed to coworkers, and degree of satisfaction with the project ascribed to management. McNemar's test and chi-square analyses were the statistical analyses performed. Purchasing locally grown produce at work apparently motivated consumers to purchase local produce outside the workplace. Workers' observations of coworker and management participation in and satisfaction with the project were associated with increased purchasing outside the workplace. Sales at worksites offer a potentially important way to increase purchases of locally grown produce. (JNE 32:304-313, 2000)

This analysis assessed whether caregivers’ reports about the amount of oil added to corn soy blend (CSB) porridge were consistent with lab analysis and whether reported sharing of CSB porridge was consistent with direct observation. This was a secondary analysis of a feasibility study assessing 2 programmatic changes in a supplementary feeding program for treatment of moderate acute malnutrition (MAM) in southern Malawi. Intervention groups received standard monthly rations of CSB with increased oil along with social behavior change communication (SBCC) to increase the amount of oil added to CSB porridge and reduce sharing. A control group received the standard CSB and oil ration. Self-reported data collected through structured interviews with caregivers were compared with laboratory analysis of CSB porridge samples and in-home observation over a 5-day period. On average, participants overreported the amount of oil used in prepared CSB porridge; self-report tended to be closer than the lab-assessed values to the amount recommended in the SBCC. Self-reported and observed sharing appeared consistent across groups. Overall, the self-reported and direct measures showed the same relationships among the groups. Self-report and objective measures were inconsistent but conveyed the same overall message. [ABSTRACT FROM AUTHOR]