A full conceptualization of the elderly food insecurity experience has been lacking, leading to limitations in the definition and measurement of food insecurity in elders. Based on the qualitative analysis of two in-depth interviews 6 mo apart with each of 53 low income urban elders, using principles of grounded theory, the experience of elderly food insecurity was shown to have four components: quantitative, qualitative, psychological and social. The inability to obtain the right foods for health is a new element specific to elders. Common to each of these components were dimensions of severity, time and compromised food choice. Although money is a major cause of food insecurity, elders sometimes have enough money for food but are not able to access food because of transportation or functional limitations, or are not able to use food (i.e., not able to prepare or eat available food) because of functional impairments and health problems. These findings suggest that augmentation of the U.S. Household Food Security Survey Module (FSSM), a national measure of food insecurity based on research in younger persons, may result in more accurate assessments for elders. We developed 14 new items for possible augmentation and administered them by telephone to these same elders along with the FSSM. Elders were independently classified according to food insecurity status based on their experience from the in-depth interviews, and these definitive criteria were used to evaluate the new and existing items. The results suggest that "couldn't afford right foods for health" and two policy-relevant immediate causes, "couldn't get the food I needed" and possibly "unable to prepare," should be added, although further testing is needed.
OBJECTIVES. Childhood overweight is an increasing public health concern. This study was undertaken to determine the prevalence of overweight in elementary school children in New York State and to identify characteristics associated with child fatness. METHODS. Weight, height, triceps skinfold, midarm circumference, and a 24-hour dietary recall were taken on 1797 second- and fifth-grade students from 51 randomly selected schools in New York State outside of New York City. Parents completed a brief questionnaire. RESULTS. In comparison with 1974 and 1980 national reference data, up to twice the expected percentages of children had values above the 85th, 90th, and 95th percentiles for body mass index, triceps skinfold, and arm fat area. Regression analyses suggested that children who tended to be fatter were members of low socioeconomic status, two-parent (but not single-parent) households; those with few or no siblings; those who ate school lunch; and those who skipped breakfast. CONCLUSIONS. The findings suggest that overweight is a problem among many elementary school children in New York State and that sociodemographic characteristics may be useful for targeting preventive efforts.
For impact evaluation and for planning and targeting decisions, local organizations in developing countries need tools for assessing household food security that go beyond measuring food availability to include access to food and perceptions of food insecurity. This paper explores the potential for developing direct measures of household food security that include such components and that are based on an in-depth understanding of the experience of food insecurity at the household level. This process was used successfully to develop the US Food Security Measure. The US approach and examples of efforts in developing countries are reviewed, along with relevant conceptual and measurement issues. The potential portability and challenges to use of the US approach in developing countries are discussed. The elements needed to apply this approach are outlined, along with operations research needed for developing such experientially based measures.
To better understand the nature of food insecurity in the elderly and to improve its measurement, in-depth interviews were conducted with 41 urban Black and rural White elderly in 35 households, followed by telephone administration of commonly used measures of food insecurity in 24 of these elderly. Elderly food insecurity appears to follow a progression of severity, beginning with compromised diet quality, followed by food anxiety, socially unacceptable meals, use of emergency food strategies, and finally actual hunger. The five quantitative measures tested were compared to each elderly person's food insecurity status based on the in-depth interview. All measures had reasonable specificity, and good sensitivity for those experiencing severe food insecurity. However, the Cornell-Radimer, Community Childhood Hunger Identification Project (CCHIP) and Nutrition Screening Initiative (NSI) measures appeared more sensitive than the USDA food sufficiency or Urban Institute measures in correctly identifying those in the lesser stages of food insecurity.
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