GLOBAL HEALTH
A Qualitative Assessment of Food Insecurity and Obesity in Jujuy, Argentina Lauren 1UCSF
• Measured by screening 300 mothers in urban health centers
- There are many negative health consequences of food insecurity, as well as lowered quality of life.
Ethel Alderete,
PhD2,
Eliseo J. Perez-Stable,
Emerging Themes
CONCLUSIONS - Mild-to-moderate food insecurity (FI) is common among urban and rural low-income households in Jujuy, Argentina. - The resulting dietary shifts likely contribute to childhood malnutrition - Solutions should consider food choices made in times of financial strain, through nutrition education and community food assistance programs. - Through lending and mutual concern, families exhibit social collectivity that could behoove future community-based food security interventions. - Participants’ mistrust and disappointment in civic structures may hinder amenability to government assistance.
RESULTS
OBJECTIVES
Participant Demographics - Examine the environmental setting, life experiences and behavioral adaptations related to food insecurity among mothers of small children in Jujuy, Argentina. - Inform future quantitative research or interventions to improve the nutritional status of low-income children in Jujuy.
SS de Jujuy (n=18 mothers) Avg. age (range) 31.1 (18-40) Indigenous 89% descent (%) Level of education 50 % completed high school Occupation 72% unemployed or housewife
Palpala (n=25 mothers) 30.5 (19-43) 76%
Humahuaca (n=9 mothers) 26 (19-39) 89%
60 % completed high school 64% unemployed or housewife
Civil status 10% single # children 0-12yrs 2.1
40% single 2.7
33% completed 52% completed high school high school 67% unemployed 67% or housewife unemployed or housewife 33% single 29% single 2.4 2.4
# people in home
7.1
4
METHODS Study Participants: Purposive sample of mothers with children 0-12 years of age attending public health clinics Quantitative: Food insecurity measured with 18-item FDA questionnaire Qualitative: 30-45 minute interview. Themes included: - Monthly household food consumption and purchase patterns - Household income and financial hardships - Barriers to food access and availability - Perceptions of community health problems; ideas for improvement
GLOBAL HEALTH
MD3
School of Medicine, 2 Universidad Nacional de Jujuy, Argentina, 3Department of General Internal Medicine, UCSF
BACKGROUND - Jujuy is a province ~900 miles NW of Buenos Aires. It borders on Chile and Bolivia. - The population in 2010: 672,000 in 2010, largely of indigenous descent. - Jujuy lags economically, partly due to the collapse of multiple mining industries in the 1990s. - Obesity is a growing problem in Jujuy among lower socio-economic status children and adults - This population also experiences food insecurity (20-30% in 2013)
Sonderegger1,
5.9
Total (n=52 mothers) 29.9 (18-43) 83%
Barriers to Food Access and Food Delivery “…Since last year when my husband lost his job, we’ve started to ration everything because we have to pay taxes, the electricity, water, gas...” (Married mother from Palpala, age 40, Food insecure with hunger - “severe”) - Inadequate finances (unemployment, other expenses, multiple kids) - Poor choice, availability or high prices of healthy foods Behavioral adaptations to food insecurity “Yes there is money however…we buy cheaper things, or we substitute for other things. Not so much vegetables because sometimes vegetables are very expensive and so no, I don’t usually add vegetables…they’re replaced with other things…” (Single mother from Palpala, age 30, food insecure without hunger) - Cyclic financial strain (monthly, weekly) - Shift to inexpensive, energy-dense and packaged foods - Decreased variety and/or quality of foods consumed; Hunger - Anxiety and guilt related to acquiring food, poor food choices, perceived harm to children’s health
“We mainly eat rice and noodles which don’t have useful vitamins or anything, bread has nothing, juice has nothing…my two older children are chubby because they go crazy over bread, they love noodles…”(Married mother from SS de Jujuy, age 20, food insecure with hunger - “moderate”) Solutions based on collaboration and community solidarity - Communal bulk food purchasing and mutual money-lending. “We have a [money] reserve, a reserve of the brickmaking group…as we are numerous and so sometimes there are families who come from Bolivia with many children, so we have to go and buy [in bulk] so that we have enough…” (Married mother from SS de Jujuy, age 26, food secure) - Community gardens, markets or communal restaurants - Government outreach regarding food and job security - Nutrition education of mothers and children
“…give a talk or rather, do a nutrition campaign and visit all the mothers of the health center, so that they take their kids for checkups and schedule them to do a nutrition talk with handouts…videos about nutrition and such, give lots of information on this topic” (Single mother from Palpala, age 30, food insecure w/hunger)
6.2
REFERENCES Level of Food Insecurity, by Site Bejarano, I.; J. Dipierri, E. Alfaro, Y. Quispe y G. Cabrera (2005). Evolución de la prevalencia de sobrepeso, obesidad y desnutrición en escolares de San Salvador de Jujuy. Archivos Argentinos de Pediatría. 103(2):101-109. ISSN: 0325-0075. Unpublished data, Alderete et al, 2013 Marina Iacovou, Deanna C Pattieson, Helen Truby and Claire Palermo (2012) Social health and nutrition impacts of community kitchens: a systematic review, Public Health Nutrition, 16(3), 535–543. Katie S. Martina, Beatrice L. Rogers, John T. Cook, Hugh M. Joseph, Social capital is associated with decreased risk of hunger. Social Science & Medicine 58(2004)2645-2654 Wright Morton L, Bitto EA, Oakland MJ, Sand M. Solving the problems of Iowa food deserts: food insecurity and civic structure. Rural Sociology. 2005; 70(1):94–112–194–112.
ACKNOWLEDGEMENTS Wara Alderete, PhD. Miriam Susana Duran Eliseo J. Perez-Stable, MD Diana Sklar Global Health Initiative Fund
• Measured by screening 300 mothers in urban health centers
- There are many negative health consequences of food insecurity, as well as lowered quality of life.
Ethel Alderete,
PhD2,
Eliseo J. Perez-Stable,
Emerging Themes
CONCLUSIONS - Mild-to-moderate food insecurity (FI) is common among urban and rural low-income households in Jujuy, Argentina. - The resulting dietary shifts likely contribute to childhood malnutrition - Solutions should consider food choices made in times of financial strain, through nutrition education and community food assistance programs. - Through lending and mutual concern, families exhibit social collectivity that could behoove future community-based food security interventions. - Participants’ mistrust and disappointment in civic structures may hinder amenability to government assistance.
RESULTS
OBJECTIVES
Participant Demographics - Examine the environmental setting, life experiences and behavioral adaptations related to food insecurity among mothers of small children in Jujuy, Argentina. - Inform future quantitative research or interventions to improve the nutritional status of low-income children in Jujuy.
SS de Jujuy (n=18 mothers) Avg. age (range) 31.1 (18-40) Indigenous 89% descent (%) Level of education 50 % completed high school Occupation 72% unemployed or housewife
Palpala (n=25 mothers) 30.5 (19-43) 76%
Humahuaca (n=9 mothers) 26 (19-39) 89%
60 % completed high school 64% unemployed or housewife
Civil status 10% single # children 0-12yrs 2.1
40% single 2.7
33% completed 52% completed high school high school 67% unemployed 67% or housewife unemployed or housewife 33% single 29% single 2.4 2.4
# people in home
7.1
4
METHODS Study Participants: Purposive sample of mothers with children 0-12 years of age attending public health clinics Quantitative: Food insecurity measured with 18-item FDA questionnaire Qualitative: 30-45 minute interview. Themes included: - Monthly household food consumption and purchase patterns - Household income and financial hardships - Barriers to food access and availability - Perceptions of community health problems; ideas for improvement
GLOBAL HEALTH
MD3
School of Medicine, 2 Universidad Nacional de Jujuy, Argentina, 3Department of General Internal Medicine, UCSF
BACKGROUND - Jujuy is a province ~900 miles NW of Buenos Aires. It borders on Chile and Bolivia. - The population in 2010: 672,000 in 2010, largely of indigenous descent. - Jujuy lags economically, partly due to the collapse of multiple mining industries in the 1990s. - Obesity is a growing problem in Jujuy among lower socio-economic status children and adults - This population also experiences food insecurity (20-30% in 2013)
Sonderegger1,
5.9
Total (n=52 mothers) 29.9 (18-43) 83%
Barriers to Food Access and Food Delivery “…Since last year when my husband lost his job, we’ve started to ration everything because we have to pay taxes, the electricity, water, gas...” (Married mother from Palpala, age 40, Food insecure with hunger - “severe”) - Inadequate finances (unemployment, other expenses, multiple kids) - Poor choice, availability or high prices of healthy foods Behavioral adaptations to food insecurity “Yes there is money however…we buy cheaper things, or we substitute for other things. Not so much vegetables because sometimes vegetables are very expensive and so no, I don’t usually add vegetables…they’re replaced with other things…” (Single mother from Palpala, age 30, food insecure without hunger) - Cyclic financial strain (monthly, weekly) - Shift to inexpensive, energy-dense and packaged foods - Decreased variety and/or quality of foods consumed; Hunger - Anxiety and guilt related to acquiring food, poor food choices, perceived harm to children’s health
“We mainly eat rice and noodles which don’t have useful vitamins or anything, bread has nothing, juice has nothing…my two older children are chubby because they go crazy over bread, they love noodles…”(Married mother from SS de Jujuy, age 20, food insecure with hunger - “moderate”) Solutions based on collaboration and community solidarity - Communal bulk food purchasing and mutual money-lending. “We have a [money] reserve, a reserve of the brickmaking group…as we are numerous and so sometimes there are families who come from Bolivia with many children, so we have to go and buy [in bulk] so that we have enough…” (Married mother from SS de Jujuy, age 26, food secure) - Community gardens, markets or communal restaurants - Government outreach regarding food and job security - Nutrition education of mothers and children
“…give a talk or rather, do a nutrition campaign and visit all the mothers of the health center, so that they take their kids for checkups and schedule them to do a nutrition talk with handouts…videos about nutrition and such, give lots of information on this topic” (Single mother from Palpala, age 30, food insecure w/hunger)
6.2
REFERENCES Level of Food Insecurity, by Site Bejarano, I.; J. Dipierri, E. Alfaro, Y. Quispe y G. Cabrera (2005). Evolución de la prevalencia de sobrepeso, obesidad y desnutrición en escolares de San Salvador de Jujuy. Archivos Argentinos de Pediatría. 103(2):101-109. ISSN: 0325-0075. Unpublished data, Alderete et al, 2013 Marina Iacovou, Deanna C Pattieson, Helen Truby and Claire Palermo (2012) Social health and nutrition impacts of community kitchens: a systematic review, Public Health Nutrition, 16(3), 535–543. Katie S. Martina, Beatrice L. Rogers, John T. Cook, Hugh M. Joseph, Social capital is associated with decreased risk of hunger. Social Science & Medicine 58(2004)2645-2654 Wright Morton L, Bitto EA, Oakland MJ, Sand M. Solving the problems of Iowa food deserts: food insecurity and civic structure. Rural Sociology. 2005; 70(1):94–112–194–112.
ACKNOWLEDGEMENTS Wara Alderete, PhD. Miriam Susana Duran Eliseo J. Perez-Stable, MD Diana Sklar Global Health Initiative Fund
