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标题：Eating When There is Not Enough to Eat: Eating Behaviors and Perceptions of Food Among Food-Insecure Youths
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作者：Rachel Widome ; Dianne Neumark-Sztainer ; Peter J. Hannan 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：99
期号：5
页码：822-828
DOI：10.2105/AJPH.2008.139758
语种：English
出版社：American Public Health Association
摘要：Objectives . We explored differences in adolescents' eating habits, perceptions, and dietary intakes by food security status. Methods . As part of Project EAT (Eating Among Teens), we surveyed 4746 multiethnic middle and high school students in 31 primarily urban schools in the Minneapolis–St. Paul, Minnesota, area during the 1998–1999 academic year. Participants completed in-class surveys. We used multiple regression analysis to characterize associations between behaviors, perceptions, nutritional intake, and food security status. Results . Compared with food-secure youths, food-insecure youths were more likely to perceive that eating healthfully was inconvenient and that healthy food did not taste good. Additionally, food-insecure youths reported eating more fast food but fewer family meals and breakfasts per week than did youths who were food secure. Food-insecure and food-secure youths perceived similar benefits from eating healthfully ( P = .75). Compared with those who were food secure, food-insecure youths had higher fat intakes ( P < .01). Food-insecure youths were more likely to have a body mass index above the 95th percentile. Conclusions . The eating patterns of food-insecure adolescents differ in important ways from the eating patterns of those who are food secure. Policies and interventions focusing on improving the foods that these youths eat deserve further examination. Food insecurity, or not having access to enough food for an active, healthy life because of a lack of resources, is a continuing problem in the United States.¹ The US Department of Agriculture monitors the extent and severity of food insecurity in US households through the food security section of the annual, nationally representative Current Population Survey. According to this survey, in 2006, 10.9% of households experienced food insecurity at some point during the year.¹ Households with children tended to be more affected by food insecurity and were nearly twice as likely to report food insecurity during at least part of the past year as were households with no children under the age of 18 years (15.6% versus 8.5%, respectively).¹ Young children are often protected from hunger even in households that have very low food security; however, adolescents may be more vulnerable.¹ Growing up in a food-insecure household places burdens on youths. Even after controlling for family income, adolescents living in food-insecure households have lower psychosocial functioning² and a greater risk of having suicidal symptoms³ than do their food-secure counterparts. Because of the increasingly prevalent childhood obesity epidemic in the United States,^{4 , 5} the effect of food security on both weight outcomes and predictors of obesity is of special interest. Youths who are racial/ethnic minorities, low income, or both are at greater risk for overweight.^{6 – 8} Several studies have found evidence for a paradoxical association between household food insecurity and overweight status in both children^{9 – 11} and adults.^{12 – 15} Other studies found no relation between food insecurity and weight in children,^{16 – 19} and several studies found a negative association.^{20 , 21} These mixed results may be because households that are characterized as food insecure likely fall at various points on a spectrum of food insufficiency and have differing coping strategies.²² Two possible interconnected mechanisms relating to eating habits that might explain why individuals who are food insecure weigh more than those who are food secure have been suggested.^{9 , 18 , 21} The first is that energy-dense foods are often cheaper in the United States and therefore may be more frequently purchased by families with limited resources to buy food.^{23 – 25} The second mechanism is that individuals facing periodic hunger and fearing food scarcity may tend to overeat when food is available.²⁶ Little is known about how food security status may influence family meal frequency, fast food use, and eating breakfast, all of which are eating habits that likely influence health. Family meal consumption is important because it has been associated with a higher quality diet^{27 – 29} and a lower likelihood of being overweight in adolescents.^{30 , 31} Additionally, family meals have been linked to adolescents having fewer high-risk behaviors, such as substance use and violence, as well as a lower risk for depression and suicide.³² Neumark-Sztainer et al.²⁷ found that lower socioeconomic status was related to a lower frequency of family meals per week. Fast-food meals tend to be high in fat, and it has been speculated that fast food in children's diets may adversely affect their dietary quality in ways that contribute to obesity.^{33 – 35} Breakfast consumption has been shown longitudinally to be protective against overweight in adolescents,³⁶ and past research has shown that compared with adolescents of lower socioeconomic status, those of higher socioeconomic status are more likely to eat breakfast.³⁷ Elucidating how household food insecurity influences eating behaviors could lead to policies and interventions that are better targeted at improving the nutritional status of youths. Using data gathered for Project EAT (Eating Among Teens), we sought to assess barriers to healthy eating as well as the availability of healthy and unhealthy foods among food-secure and food-insecure adolescents. We also aimed to compare eating habits and nutritional intake between these 2 groups. We hypothesized that food-insecure adolescents would report eating habits that were less healthy, poorer nutritional intakes, decreased healthy food availability in the home, and greater perceived barriers to healthy eating.