A Socioecological Analysis of Food Insecurity and Implications for Weight Management in Low-Income Populations Público
Genkin, Brooke Heather (2013)
Abstract
INTRODUCTION: Obesity is one of the greatest health problems currently confronting our nation. The consequences of obesity affect physical, mental, and psychosocial health. Individuals of lowest income are particularly affected by obesity and chronic disease onset. Additionally, individuals belonging to lower socioeconomic statuses are most affected by food insecurity. This study examined correlates of food insecurity through a socioecological framework examining community, home, and individual level associations as well as the relative contribution of food insecurity to weight and weight-related eating behavior over the course of a weight gain prevention program. METHODS: Secondary data from a previous weight gain prevention trial were used. Participants were 119 residents of Cook, Randolph, and Mitchell counties of Georgia; however only 92 participants were included in the longitudinal analyses. Community, home, and individual factors related to food availability and access were assessed via self-report. The BRFSS fruit and vegetable screener and NCI Fat screener were used at three time-points to measure change in weight-related eating behavior. Data from baseline and third time points were used in the current study. RESULTS: Food insecure participants were more likely to be Non-white, have lower education, lower incomes, and live in households with more people (ps<.005) than food secure participants. Additionally, food insecure participants more often ranked healthy food as unaffordable and had different priorities in purchasing food ranking cost, convenience, and weight control significantly more important than food secure individuals (ps≤.001). Weight status, BMI, and weight in pounds were also significantly different between the groups (ps<.05), as was fruit and vegetable intake (p=.007), but the difference in fat intake was not significant. In longitudinal regression analyses, additional household members predicted higher fat intake over time (p<.05). No other significant correlates of interest were found in regression analyses. DISCUSSION: Results suggest that food insecurity is an important factor to consider in designing community-based weight gain prevention programs that future practice and research should take into consideration in designing relevant interventions.
Key words: obesity, food insecurity, weight gain prevention, weight management
Table of Contents
Table of Contents
CHAPTER I: INTRODUCTION........... 1
Obesity....... 1
Food Insecurity....... 2
Food Insecurity and Obesity in Low-Income Populations....... 3
Gender Differences in Food Insecurity and Eating Behavior....... 4
Problem Justification....... 5
Theoretical Framework....... 8
Theoretical Framework: Socioecological Model..... 8
Theoretical Framework: Social Cognitive Theory..... 10
Devising a Conceptual Model....... 11
Purpose of the Study....... 13
Research Questions....... 14
CHAPTER II: LITERATURE REVIEW........... 15
Introduction....... 15
Obesity Disparities..... 15
Obesity, disparities, and weight management: why food insecurity is a real threat..... 16
Obesity and Food Insecurity....... 18
Community Level Factors....... 20
Proximity of grocery stores and food insecurity..... 22
Food offerings at stores and food insecurity..... 24
Affordability of healthy foods at stores and food insecurity..... 25
Home Level Factors....... 28
Food purchasing decision-making and food insecurity..... 28
Household income per person and food insecurity..... 30
Home food environment, food insecurity, and eating behavior..... 33
Individual Level Factors....... 35
Gender and food insecurity..... 36
Other individual level variables and food insecurity..... 38
Health Outcomes....... 39
Fat intake and food insecurity..... 39
Fruit and vegetable intake and food insecurity..... 40
Weight and food insecurity..... 42
Theoretical Background....... 43
Socioecological Model and eating behavior..... 43
Social Cognitive Theory and eating behavior..... 45
Integration of multiple theories and eating behavior..... 46
Summary....... 47
Participants....... 48
Recruitment of primary participants..... 49
Recruitment of secondary participants..... 50
Compensation..... 50
Procedure....... 50
Intervention..... 51
Comparison..... 52
Data Collection....... 52
Measures..... 53
Data Analysis....... 58
Univariate Analyses..... 58
Bivariate Analyses..... 59
Multivariate Analyses..... 59
Research Questions..... 60
CHAPTER IV: RESULTS........... 62
Sample Characteristics....... 62
Baseline Sample Characteristics Associated with Food Security Status....... 63
Community Level Variables..... 66
Home Level Variables..... 67
Individual Level Variables..... 67
Health Outcome Variables..... 67
Change in Health Outcome Variables..... 68
Examining Correlates of Baseline Fat Intake....... 70
Examining Correlates of Baseline Fruit and Vegetable Intake....... 71
Examining Correlates of Weight in Pounds at Baseline....... 72
Examining Correlates of Change in Fat Intake....... 73
Examining Correlates of Change in Fruit and Vegetable Intake....... 74
Examining Correlates of Change in Weight....... 75
Summary....... 76
Findings....... 77
Food insecurity and perceived affordability of health food..... 79
Food insecurity and food purchasing decision-making..... 79
Food insecurity and eating behavior..... 81
Non-significant findings..... 81
Limitations....... 83
Delimitations....... 86
Recommendations for practice..... 87
Recommendations for research..... 88
Conclusions....... 90
References....... 92
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