Search Results (62)

Short sleep duration (≤6 h) is a public health concern linked to cardiometabolic disease and premature mortality. However, persistent disparities across sociodemographic, psychosocial, and structural domains remain underexplored in recent nationally representative samples. We analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data, including 228,463 adults (weighted N ≈ 122 million). Sleep duration was dichotomized as short (≤6 h) versus adequate (≥7 h). Complex samples logistic regression estimated associations between sociodemographic, psychosocial, behavioral, and structural determinants and short sleep, accounting for survey design. The weighted prevalence of short sleep was 33.2%. Non-Hispanic Black (AOR = 1.56, 95% CI: 1.46–1.65) and American Indian/Alaska Native adults (AOR = 1.46, 95% CI: 1.29–1.65) were disproportionately affected compared with non-Hispanic White adults. Psychosocial factors contributed strongly: life dissatisfaction, limited emotional support, and low social connectedness increased odds, whereas high connectedness was protective. Food insecurity and smoking were significant structural and behavioral risks, while binge drinking and urbanicity were not. One-third of U.S. adults report short sleep, with marked disparities across demographic, socioeconomic status, psychosocial stressors, and structural barriers. Findings highlight the multifactorial nature of sleep health inequities and the need for multilevel interventions addressing both individual behaviors and upstream determinants. Full article

Objective: This study aimed to evaluate food insecurity and associated factors during and after remote learning among undergraduates at Brazilian public universities. Methods: This is a comparative study of two cross-sectional studies; the first had its data collection from August 2020 to February 2021, and the second from May 2023 to December 2023. The questionnaire contained socio-economic variables, the Brazilian Food Insecurity Scale, the Diet Quality Scale, and the Perceived Stress Scale. Results: In total, 4799 undergraduates of Brazilian public universities responded in the first study, and 2897 responded in the second. Food insecurity was present in 36.5% of the students in 2020/2021 and 35.9% of the students in 2023. In the correspondence analysis, low income, poor health, stress and poor diet were associated with food insecurity in 2020/2021. Low income, reduced income, poor health, stress and diet quality were associated with food insecurity in 2023. Logistic regressions demonstrated that the year of collection, whether during or after remote learning, did not significantly contribute to food insecurity. However, students from low-income families had the highest AOR for food insecurity; no change in income or weight and lower perceptions of stress were associated with a lower AOR for food insecurity. Full article

Food insecurity remains a persistent global challenge, despite significant advancements in agricultural production and technology. The main objective of this study is to identify and quantitatively assess some of the structural determinants influencing country-level food insecurity and provide an empirical background for policy-making aimed at achieving the Sustainable Development Goal of Zero Hunger (SDG 2). This study employs a beta regression model in order to study moderate or severe food insecurity across 153 countries, using a cross-sectional dataset that integrates economic, agricultural, political, and demographic independent variables. The analysis identifies low household per capita final consumption expenditure (β = −9 × 10⁻⁵, p < 0.001), high income inequality expressed as a high GINI coefficient (β = 0.047, p < 0.001), high long-term inflation (β = 0.0176, p = 0.003), and low economic globalization (β = −0.021, p = 0.001) as the most significant predictors of food insecurity. Agricultural variables such as land area (β = −1 × 10⁻⁵, p = 0.02) and productivity per hectare (β = −9 × 10⁻⁵, p = 0.09) showed limited but statistically significant inverse effects (lowering food insecurity), while factors like unemployment, political stability, and conflict were not significant in the model. The findings suggest that increased economic capacity, inequality reduction, inflation control, and global trade integration are critical pathways for reducing food insecurity. Future research could employ beta regression in time-series and panel analyses or spatial models like geographically weighted regression to capture geographic differences in food insecurity determinants. Full article

Background/Objectives: Food insecurity (FI) is a well-defined factor in pediatric health outcomes and has been associated with lower diet quality. While poor diet quality has been linked to the rising prevalence of inflammatory bowel disease (IBD), little is known about the impact of FI on pediatric IBD. This pilot study explores the feasibility and potential impact of FI on dietary intake and clinical outcomes in children with newly diagnosed IBD. Methods: This pilot study included newly diagnosed IBD patients aged 5 to 18. FI screening was completed using the USDA 6-item and AAP 2-item screeners at diagnosis and 6 months. Dietary intake was classified according to their degree of processing (NOVA classification). Clinical data, anthropometrics, and healthcare utilization were collected over 6 months. Results: Among 20 patients, FI was identified in 40% of families. Food-insecure patients had significantly lower weight and BMI z-scores at diagnosis compared to food-secure peers (p = 0.002 and p = 0.0013, respectively). Food-insecure patients consumed more ultra-processed foods (UPFs, 70.6% vs. 66.7%, p = 0.473). However, most patients consumed diets high in ultra-processed foods. FI status was dynamic over the study period. Hospitalizations were more frequent among food-insecure patients. Conclusions: FI is common in pediatric IBD and associated with poorer nutritional status. FI was associated with higher consumption of UPFs, although diet quality was poor among most patients. Future studies should validate these findings in large cohorts and evaluate longitudinal interventions. Full article

Widespread job losses and economic disruptions during the COVID-19 pandemic led to significant housing payment insecurity, disproportionately affecting various demographic groups and regions across the United States (US). While previous studies have explored the pandemic’s impact on housing insecurity, they all focused on specific periods, populations or areas. No study has yet provided a comprehensive analysis of inequality in housing insecurity throughout the pandemic, particularly in terms of spatial disparities. Our study addresses this gap by analyzing individual-level and aggregated data from the Household Pulse Survey (HPS) (N = 2,062,005). The findings reveal heightened vulnerability among individuals aged 40–54, those with lower education and income, Black and Hispanic/Latino populations, women, households with children, individuals who experienced job loss, the divorced, and larger households. Renters experienced greater housing insecurity than homeowners. A hotspot analysis identified the southeastern US as a region of acute housing insecurity, revealing that insecurity cannot be solely measured by affordability. The regression results show that poverty is the main reason for differences in housing insecurity across places, and rent burden is also important. The geographically weighted regression (GWR) model shows stronger coefficients in southern states, highlighting that poverty and rent burden are particularly influential factors in these areas. This study shows the multifaceted nature of housing insecurity, calling for targeted group or location policy interventions. Full article

Despite growing recognition of the role that social determinants of health (SDOHs) and health-related social needs (HRSNs) play in chronic disease, limited research has examined their associations with Chronic Obstructive Pulmonary Disease (COPD) in population-based studies. This cross-sectional study analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data from 37 U.S. states and territories to determine how financial hardship, food insecurity, employment loss, healthcare access barriers, and psychosocial stressors influence the prevalence of COPD. Weighted logistic regression models were used to assess the associations between COPD and specific SDOHs and HRSNs. Several individual SDOH and HRSN factors were significantly associated with COPD prevalence, with financial strain emerging as a particularly strong predictor. In models examining specific SDOH factors, economic hardships like inability to afford medical care were strongly linked to higher COPD odds. Psychosocial HRSN risks, such as experiencing mental stress, also showed moderate associations with increased COPD prevalence. These findings suggest that addressing both structural and individual-level social risks may be critical for reducing the prevalence of COPD in populations experiencing financial challenges. Full article

Background: Prematurity and low birth weight (LBW) drive infant morbidity and mortality, requiring nutritional interventions, especially in food-insecure settings. In Indonesia, regional disparities in food security hinder adequate nutrition for premature and LBW infants, exacerbating health challenges. The aim of study is to investigate and determine factors associated with prematurity and LBW in children from food-insecure and food-secure households. Methods: This research employed a cross-sectional study with 657 mothers of children aged 36–59 months, conducted using random sampling. Data was collected via standardized questionnaires and analyzed using Chi-square tests and logistic regression. Results: The adjusted model showed that children of food-insecure households had a higher risk of LBW (AOR = 0.54; 95% CI: 0.29–0.99; p < 0.05). LBWs were found to significantly less occur in food-insecure households. Low maternal education was associated with an increased risk of preterm birth (AOR = 3.23; 95% CI:1.78–5.84; p < 0.001). Furthermore, prematurity correlated with house ownership (p < 0.01), indicating the household’s wealth condition. Maternal education and house ownership were linked to prematurity, indicating the risk to child health outcomes. In summary, maternal education, employment status, and household income were linked to food insecurity, indicating the risk to child health outcomes. Conclusion: Strategies to improve child health outcomes are essential, including enhancing maternal nutrition knowledge to improve child feeding practices, promoting gender equality in career development, and reducing food insecurity in households. Full article

Background: Breastfeeding is essential for preventing non-communicable diseases. However, mothers with chronic illnesses tend to breastfeed less, increasing the likelihood of abandoning breastfeeding, especially if they experience gestational complications. Objective: To analyze the association between factors such as prepregnancy maternal characteristics, gestational complications, food security, barriers, and facilitators with the practice of exclusive breastfeeding. Methods: Cross-sectional study with 566 women who had prenatal care and gave birth at the National Institute of Perinatology (Mexico City) between 2021 and 2024. Surveys were administered on breastfeeding practices, food insecurity, barriers, and facilitators of exclusive breastfeeding in mothers. In addition, sociodemographic information, medical history (prepregnancy conditions and complications), gestational weight gain, and neonatal outcomes were recorded. Results: Of the 566 women, only 43.6% practiced exclusive breastfeeding, with a median duration of 4 months. Exclusive breastfeeding was more frequent in young, stay-at-home mothers with lower educational attainment and in those with food insecurity, who also tended to delay the introduction of complementary foods until after six months. Prepregnancy risk conditions (OR 1.56, 95% CI 1.06–2.30) and multiparity (OR 1.64, 95% CI 1.08–2.49) increased the risk of non-exclusive breastfeeding. Conversely, food insecurity (OR 0.40, 95% CI 0.20–0.78) and counseling from healthcare personnel (OR 0.09, 95% CI 0.01–0.51) showed a protective effect. The analysis also showed that paid employment (OR 4.68, 95% CI 1.65–13.21), the perception of low milk production (OR 6.45, 95% CI 2.95–14.10), maternal illness/medication (OR 3.91, 95% CI 1.36–11.28), and fatigue (OR 4.67, 95% CI 1.36–11.28) increased the probability of non-exclusive breastfeeding. Conclusions: In Mexico, the promotion of exclusive breastfeeding faces challenges, especially in mothers who begin pregnancy with significant chronic conditions such as diabetes, hypertension, obesity, advanced maternal age, and hypothyroidism, among others. Healthcare personnel should provide personalized advice to each woman from the prenatal stage on strategies to achieve and maintain exclusive breastfeeding. Full article

Ensuring the security of agricultural systems is essential for achieving national food security and sustainable development. Given that agricultural systems are inherently complex and composed of coupled subsystems—such as water, land, and energy—a comprehensive and multidimensional assessment of system security is necessary. This study focuses on Northeast China, a major food-producing region, and introduces the concept of agricultural system coupling security, defined as the integrated performance of an agricultural system in terms of resource adequacy, internal coordination, and adaptive resilience under external stress. To operationalize this concept, a coupling security evaluation framework is constructed based on three key dimensions: reliability (Rel), coordination (Cor), and resilience (Res). An Agricultural System Coupling Security Index (AS-CSI) is developed using the entropy weight method, the Criteria Importance Through Intercriteria Correlation (CRITIC) method, and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method, while obstacle factor diagnosis is employed to identify key constraints. Furthermore, bivariate and trivariate Copula models are used to estimate joint risk probabilities. The results show that from 2001 to 2022, the AS-CSI in Northeast China increased from 0.38 to 0.62, indicating a transition from insecurity to relative security. Among the provinces, Jilin exhibited the highest CSI due to balanced performance across all Rel-Cor-Res dimensions, while Liaoning experienced lower Rel, hindering its overall security level. Five indicators, including area under soil erosion control, reservoir storage capacity per capita, pesticide application amount, rural electricity consumption per capita, and proportion of agricultural water use, were identified as critical threats to regional agricultural system security. Copula-based risk analysis revealed that the probability of Rel–Cor reaching the relatively secure threshold (0.8) was the highest at 0.7643, and the probabilities for Rel–Res and Cor–Res to reach the same threshold were lower, at 0.7164 and 0.7318, respectively. The probability of Rel–Cor-Res reaching the relatively secure threshold (0.8) exceeds 0.54, with Jilin exhibiting the highest probability at 0.5538. This study provides valuable insights for transitioning from static assessments to dynamic risk identification and offers a scientific basis for enhancing regional sustainability and economic resilience in agricultural systems. Full article

Background/Objectives: Gestational weight gain (GWG) is a critical determinant of pregnancy outcomes; however, studies on factors contributing to suboptimal GWG in developing countries, including Malaysia, remain limited. Methods: This study employed an explanatory sequential mixed-methods design, with the quantitative phase conducted between January and March 2020, followed by the qualitative phase from July 2020 to March 2021 in Selangor. The qualitative phase aimed to explain the factors influencing suboptimal (inadequate and excessive) GWG identified in the quantitative phase. Inclusion criteria included Malaysian women aged 18 and above who had suboptimal GWG (either inadequate or excessive) from the quantitative phase. Exclusion criteria included women who refused participation. Of the 475 participants from the quantitative phase, 20 with suboptimal GWG were purposively selected for in-depth telephone interviews using a semi-structured interview protocol. Data were analysed using thematic analysis. Results: Three key themes emerged: (1) the impact of pre-pregnancy overweight and obesity, shaped by unhealthy lifestyles, social influences, and limited access to nutritious food and physical activity; (2) the management of diabetes during pregnancy, contributing to inadequate GWG due to psychological responses, restrictive behaviours, and barriers to dietary guidance; and (3) financial constraints in middle- and low-income households, leading to income vulnerability, financial crises, and food insecurity. Conclusions: This finding highlights the urgent need for targeted interventions to optimize GWG, emphasizing pre-pregnancy health optimization, enhanced diabetes management, and strategies to mitigate financial constraints and food insecurity among pregnant women. Full article

Introduction. Obesity is a complex condition associated not only with physical health risks but also with social discrimination and a reduced quality of life (QoL). Psychological factors, including attachment styles, may play a role in emotional regulation and eating behaviors. According to attachment theory, insecure attachment is linked to difficulties in managing emotions and an increased likelihood of engaging in dysfunctional eating patterns. This study aimed to investigate the relationship between past and present attachment styles, binge-eating behaviors, and QoL scores in individuals with overweight or obesity (BMI ≥ 25 kg/m²) compared to those with a BMI in the normal weight range (18.5–24.9 kg/m²). Methods. A cross-sectional study evaluated 96 women with overweight/obesity and 96 women with normal weight. Psychological measures included the Parental Bonding Instrument (PBI), the Attachment Style Questionnaire (ASQ), the Binge Eating Scale (BES), and the Obesity-Related Well-being questionnaire (ORWELL 97). Data analysis included between-group comparisons of attachment dimensions and hierarchical regression to examine associations with the QoL score. Results. Participants with overweight/obesity showed less secure attachment (U = 5508, p = 0.019) and more avoidant attachment styles (U = 3825, p = 0.042) compared to participants with normal weight. Conversely, no significant differences were observed in PBI scores. Regression analysis revealed that attachment anxiety (B = 0.83, p = 0.009) and binge-eating behaviors (B = 0.57, p = 0.003) were significantly associated with a lower QoL. Conclusions. Obesity is associated with avoidant attachment in adulthood, but no differences were found in parental attachment when compared to individuals with normal body weight. Anxious attachment in individuals with obesity is strongly linked to reduced QoL, underlying the role played by attachment-related factors in the psychosocial challenges individuals often have to face. Full article

Background/Objectives: Brazil has a high incidence of new tuberculosis cases influenced by socioeconomic factors. Inadequate housing, limited access to health services, and insufficient food increase vulnerability to the disease. This study aimed to identify sociodemographic, nutritional, and anthropometric factors associated with active pulmonary tuberculosis. Methods: This case–control study was conducted at the tuberculosis (TB) Referral Hospital in São Luís, Maranhão, Brazil, from 2022 to 2024. It included 65 patients with active pulmonary TB and 73 comparison individuals. Sociodemographic and nutritional data were collected using an adapted semi-quantitative questionnaire with 77 items, based on the validated ELSA-BRASIL questionnaire for adults, to assess the consumption of calcium, phosphorus, iron, zinc, vitamin B3, vitamin B6, vitamin C, vitamin E, and vitamin D. The Brazilian Food Insecurity Scale (EBIA) was used to analyze food and nutrition security or insecurity. Body Mass Index (BMI) was calculated based on weight and height measurements. Results: The TB patients were predominantly men (73.8%), of mixed ancestry (69.4%), with low education levels (73.4%), and had a mean age of 39 years. Furthermore, 26.2% of the patients were underweight, and 64% experienced some degree of food and nutrition insecurity. The variables education level, vitamin D, and BMI were associated with the outcome in the final model. Conclusions: The study identified a high prevalence of food insecurity and vitamin E deficiency in individuals with active tuberculosis, in addition to associating low educational levels, inadequate vitamin D intake, and overweight with a higher risk of TB. Although it has limitations, such as the cross-sectional design and sample size, the results highlight the importance of these determinants and point to the need for longitudinal research to confirm and expand the evidence. Full article

Background: Binge eating disorder (BED) is characterized by episodes of uncontrollable eating, defined by the rapid consumption of large quantities of food over a short period. This condition is associated with a variety of psychological and non-psychological factors, including behavioral, biological, genetic, neurological, and pharmacological influences, all of which adversely affect patients’ daily lives. BED is linked to numerous health consequences, such as obesity, atherosclerosis, diabetes, chronic pain, and hypertension. Although BED is not exclusive to individuals with obesity, it is more prevalent in this population, who also face a heightened risk of developing metabolic syndrome (MetS). The latter is a cluster of five risk factors—obesity, hyperlipidemia, hyperinsulinemia, hypertension, and hyperglycemia—that significantly increase the likelihood of chronic diseases. Methods: This narrative review synthesizes existing research to explore the association between BED and MetS, examining shared pathophysiological mechanisms and clinical implications. It also highlights the role of escalating food insecurity and ongoing political, economic, and health crises in the development of BED. Results: BED is significantly associated with MetS components, including hypertension, obesity, type 2 diabetes, and dyslipidemia, all contributing to increased morbidity and mortality. Beyond body weight, behavioral, genetic, biological, and neurological factors mediate this relationship. Conclusions: BED is strongly linked to MetS through shared behavioral, genetic, and biological pathways. Early detection, integrated management strategies, and further research are crucial to addressing the public health challenges posed by this association. Full article

Background/Objectives: Evidence suggests that food insecurity (FI) is a risk factor for eating disorder (ED) symptoms, especially binge eating (BE), yet research focusing on the psychosocial effects among midlife/older women is lacking. Midlife/older women living with FI experience intersectional disadvantage, thus highlighting the need for an independent investigation of the cultural and contextual factors of this population. The current study examined the difference in psychological health and quality of life (QOL) among women living with BE and FI (BE + FI) versus FI without BE. Method: Female clients of a food bank, aged 50+ (N = 295; M age = 62.1 years, SD = 8.2) living with FI completed measures of BE and psychosocial comorbidities. The measures were provided in English and Spanish. Results: A multivariate analysis of covariance compared women living with BE and FI (BE + FI) versus FI without BE on outcomes related to mental health and wellbeing. Covarying for age, FI severity, and ethnicity, the results indicated that women living with BE + FI reported worsened anxiety, depression, ED-related psychosocial impairment, internalized weight stigma, and QOL versus women living with FI without BE (all ps < 0.001). Effect sizes ranged from small to medium to large. Conclusions: Midlife/older women living with BE + FI report poorer psychological health and QOL than those living with FI without BE, demonstrating a critical need for mental healthcare in this population. Innovative solutions—and likely a portfolio of interventional approaches with various entry points and delivery modalities—are warranted, if we are to make significant strides in addressing ED symptoms in this population. Full article

Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the United States (U.S.). Mississippi has the highest rate of CRC incidence in the U.S. and has large populations of black and white individuals, allowing for studies of racial disparities. Methods: We conducted an ecological study using the county as the unit of analysis. CRC incidence data at the county level for black and white populations in Mississippi, covering the years 2003 to 2020, were retrieved from the Mississippi Cancer Registry. Age-adjusted incidence rate differences and their corresponding 95% confidence intervals (CIs) were then calculated for these groups. Getis–Ord Gi* hot and cold spot analysis of CRC incidence rate racial disparities was performed using ArcGIS Pro. We used global ordinary least square regression and geographically weighted regression (MGWR version 2.2) to identify factors associated with racial differences in CRC incidence rates. Results: Age-adjusted CRC incidence rate in the black population (median = 58.12/100,000 population) and in the white population (median = 46.44/100,000 population) varied by geographical area. Statistically significant racial differences in CRC incidence rates were identified in 28 counties, all of which showed higher incidence rates among the black population compared to the white population. No hot spots were detected, indicating that there were no spatial clusters of areas with pronounced racial disparities. As a post hoc analysis, after considering multicollinearity and a directed acyclic graph, a parsimonious multiple regression model showed an association (β = 0.93, 95% CI: 0.25, 1.62) indicating that a 1% increase in food insecurity was associated with a 0.93/100,000 differential increase in the black–white CRC incidence rate. Geographically weighted regression did not reveal any local patterns in this association. Conclusions: Black–white racial disparities in CRC incidence were found in 28 counties in Mississippi. The county-level percentage of food insecurity emerged as a possible predictor of the observed black–white racial disparities in CRC incidence rates. Individual-level studies are needed to clarify whether food insecurity is a driver of these disparities or a marker of systemic disadvantage in these counties. Full article