EAL

HD: Food Security (2011)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To study how poverty-associated food deprivation in childhood might influence attitudes toward and the use of food in later life.

Inclusion Criteria:

Participating families included:

A mother who was at least 18 years old
At least one child 12 years or younger
An annual household income of less that 200% of the federal poverty level.

Exclusion Criteria:

One participant declined to be interviewed after the first session and was therefore excluded.

Description of Study Protocol:

Recruitment

New York state data from a large longitudinal multi-state research project "Rural Low-Income Families: Tracking Their Well-being and Functioning in the Context of Welfare Reform (Rural Families Speak, 2002) was used.

Design

Quantitative and qualitative data collected in a triangulation mixed-methods design using personal interviews, food security status assessment and (in New York only) measured weight, reported height and review of disordered eating patterns.

Blinding Used

All participants were assigned pseudonyms to maintain anonymity but this was not necessarily blinded from the researchers.

Statistical Analysis

Fisher's exact test or X²test and constant comparative method.

Data Collection Summary:

Timing of Measurements

Three waves of data collection per participant during a four-year period from 2000 to 2003.

Dependent Variables

Mother's weight status
Food security
Eating patterns.

Independent Variables

Childhood socioeconomic status of the mother
Age
Education level
Number of children in household
Race
Marital status.

Control Variables

Subjects were compared to their own history report.

Description of Actual Data Sample:

Initial N: 31 females
Attrition (final N): 30 females
Age: 19 to 48 years (77% 20 to 30 years; 10% 19 years; 13.3% 40 years or more)
Ethnicity: 90% white, 3.3% black, 6.7% multi-racial
Other relevant demographics: 50% employed outside of the home
Anthropometrics: 30% obese (BMI more than 30), 30% overweight (BMI 25.0 to 29.9), 30% normal weight (BMI 18.5 to 24.9), 10% underweight (BMI less than 18.5)
Location: New York State.

Summary of Results:

Key Findings

Growing up in a household that was poor was significantly (P<0.01) associated with increased likelihood of being overweight or obese as an adult but was not significantly associated with current eating patterns such as binge eating nor current food security
Eating pattern score was positively and significantly (P<0.05) associated with being overweight or obese
Food insecurity was significantly (P<0.05) associated with eating pattern score only when using the Radimer et al method (not the US Household Survey).

Other Findings

Qualitative review of interview topics discuss participant individual experiences and reactions to food insecurity.

Author Conclusion:

Food deprivation in childhood and associated attitudes and behaviors towards food are one possible mechanism for explaining the association between childhood poverty and adult obesity.

Funding Source:

Government:	USDA/SDREES/NRICCP grants
University/Hospital:	Cornell University Agricultural Experiment Station

Reviewer Comments:

This was small, predominantly white sample. The qualitative information is interesting but difficult to utilize objectively.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		Yes
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	No
3.	Were study groups comparable?		Yes
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	Yes
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	Yes
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	No
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	Yes
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	Yes
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	Yes
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	Yes
5.	Was blinding used to prevent introduction of bias?		No
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	No
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	No
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	No
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	Yes
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	Yes
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	Yes
	6.6.	Were extra or unplanned treatments described?	No
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	Yes
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	Yes
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	Yes
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	Yes
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	No
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes