Interim findings from systematic review of Household Food

Interim findings from systematic review of Household Food Insecurity Measures used in high income countries Giang Nguyen Flora Douglas Geraldine Mc. Neill Lorna Aucott Household food insecurity measurement in Scotland: Dec 2016 update and workshop Serenity Café, Edinburgh 13 th December, 2016

Systematic search to identify HFI measures used in high income countries • Study question: “Which HFI measurement will be applicable to use in the Scottish context? ” • Study aim: Identify existing empirical studies which have measured HFI in high income countries (classified by the World Bank) • Search strategy: – 3 key terms: – food insecurity; – high-income countries – measurement – Time period restriction: 1996 - 2016 • Electronic databases searched : Medline, Embase, CINAHL • English Language only

Papers retrieved

Systematic search to identify HFI measures used in high income countries • 572 is too many to get full text for • Most would not answer our RQ anyway (identify different HFI measures) • Instead we extracted a fair amount of information from just the abstracts • Data extraction (abstracts and papers) – Country – Study focus (gender, age, study population, income level) – Food insecurity measure? Full or short form? – Study aim – Study method… etc • If without citation or was a different HFI measures was further investigated: – If from USA or CANADA within the last 10 years were assumed to be USDA or the Canadian tool (to be verified) – Otherwise the Full text papers was obtained to id any new HFI tools for further reading and information

Household food insecurity measurement- data extraction form

Analysis • Not a traditional systematic review • Review aims to identify: – which HFI measure was used – in what context, – with which group, – for what purpose Not concerned with prevalence or any health or social outcomes associated with HFI This will be more fully analysed later. For now 7 different HFI measurement tools have been identified

Overview of 7 food insecurity measures Radimer. Cornell USDA LIDNS Brazilian Canadian HFIES 1992 1995 2003 2004 2006 2013 English, Iran, Russian etc English, Spanish, Chinese etc English Portuguese English, French English etc Used in 145 countries Organization/ Country Cornell University, USA The U. S Department of Agriculture UK Food Standards Agency Brazilian Institute of Geography and Statistics Health Canada FANTA-USAID FAO Unit of study • Household • Women • Children Year Language Assessment timeframe Screening question Food Security Status Categories Not specified • Individual • Household with and without children Last 12 months • Individual • Household with and without children Last 3 months • Individual • Household with and without children Last 12 months No Yes In the past 4 weeks (30 days) No • Food secure • Mildly food insecure • Moderately food insecure • Severely food insecure • Food secure • Marginally food insecure • Moderately food insecure • Severely food insecure • Food secure • Mildly food insecure • Moderately food insecure • Severely • Hunger • Household • Women and child level • Food secure • Low food • Food security insecure • Very low food • Mildly food security insecure • Moderately food insecure • Household • Individual • Household Last 12 months No Mild food insecurity to severe food insecurity

The core domain of food insecurity

Food insecurity domains ( as defined in the Radimer Cornell questionnaire) • Quantitative: Insufficient food intake: not enough food to eat • Qualitative: Quality of food intake or nutrition inadequacy: not eating a complete or balanced meal • Social component: disrupted eating pattern (individual level) or food acquisition in socially unacceptable ways (household). For example: skip meal or gone without food or not eating for a whole day). • Psychological (at individual level) lack of choice and created feeling of deprivation.

Food insecurity domains Domain Radimer. Cornell USDA Canadian LIDNS HFIAS Brazilian FIES Quantitative 11 9 9 8 6 7 4 Qualitative 8 3 3 1 0 2 1 Social 7 4 4 4 1 4 2 Psychological 4 1 1 1 3 1 1 Weight loss 0 1 1 1 0 Total 30 18 18 15 9 15 8

Comparing food insecurity items from the USDA, Canada, LIDNS and Brazilian questionnaires Canadian LIDNS Brazilian Q 0. Screening question Q 1 Preliminary question - Q 1. Worry about running out of food Q 2 Q 1 Q 2. Food didn’t last Q 3. Balance meals/ healthy food Q 3 Q 4 Q 2 Q 3 Q 8 b (Q 9) Q 10 (Q 11) Q 12 (Q 4) Q 5 Q 6 Q 7 Q 8 Q 9 Q 3* (healthy and varied diet) Q 7 (Q 8) Q 9 Q 10 (Q 11) (go without eating for a whole day) Q 12 b Q 5 Q 10 - Q 4* Q 6 - Q 13. Child not eating enough food Q 7 - Q 5* (healthy and varied diet) Q 6 Q 14. Cut the size of children meals Q 15. Child were hungry Q 16. Child skip meals Q 17. (if yes to Q 16) Q 18. Child ever not eat for a whole day Q 13 Q 11 Q 14 Q 12 Q 13 Q 15 Q 4. Cut the size or skip meals Q 5. (if yes to Q 4) Q 6. Eat less Q 7. Being hungry Q 8. Lose weight Q 9. Not eating for a whole day Q 10. (If yes to Q 9) Q 11. Eat only few kinds of low-cost food Q 12. Feed children a balance meals Q 15 Q 14 b Q 16 1. Q: similar; (Q): quite similar (in wording) and Q*: not very similar 2. USDA, Canadian, LIDNS questions used “… money for food” meanwhile Brazilian questions used “…money to buy food” 3. Additional question in Brazilian questionnaire: “did you run out of food before having money to buy more? ” 4. 14 questions in Brazilian questionnaire (except Q 10) have an affirmative response “how often did it happen? ” (Q 12) Q 14 Q 13 (Q 15) (go without food)

Compared table of Radimer-Cornell questionnaire with USDA, HFIAS and FIES questionnaires Radimer-Cornell Household items Women’s items Food depletions items 1. Amount of food enough to buy food 2. Food runs out 3. Food didn’t last 4. No food for meal Food anxiety items 5. Worry if food run out 6. Worry if food enough 7. Don’t know how to get food 8. Worry next day’s food Diet inadequacy items 9. Woman does not eat as should 10. Woman cannot afford nutritious diets 11. Woman eats properly? 12. Woman does not eat balanced meal Intake insufficiency items 13. Woman wants to eat more but no money 14. Woman goes hungry 15. Woman eats less Disrupted eating pattern items 16. Woman goes without eating 17. Woman skip meals 18. Woman eat once a day 19. Woman does not eat for whole day USDA HFIAS FIES Q 2 Q 1 Q 3 Q 7 Q 6 Q 4 Q 9 Q 1 Q 8 Q 9 Q 6 Q 1 Q 2 Q 7 Q 5 Q 4 Q 8

Compared table of Radimer-Cornell questionnaire with USDA, HFIAS and FIES questionnaires (cont) Radimer-Cornell Children’s items USDA HFIAS FIES Diet inadequacy items 20. Child composite index - - - 21. Child does not eat nutritious diet - - - 22. Child does not eat balanced meals Q 12 - - 23. Child can’t be fed as should - - - Intake insufficiency items 24. Child eat less - - - 25. Child wants more food - - - 26. Child doesn’t eat enough Q 13 - - 27. Child hungry Q 15 - - Disrupted eating pattern items 28. Child goes without food - - - 29. Child skips meals Q 16 - - 30. Child does not eat for whole day Q 18 - -

Acknowledgement Dr Amudha Poobalan for her input and advice re systematic review search strategy

Small group discussion questions • What three things from this morning’s presentations were the most interesting and / or concerning? • What actions would you like to see coming out of today’s workshop?