Food Environment, Food Insecurity, and Health Behaviors in NH Hispanics

Primary outcomes

1. The correlation between weight status and indicators of physical and psychological wellbeing during the COVID-19 pandemic.

   Time frame: March 2021 - September 2021

   Physical activity will be assessed with the Global Physical Activity Questionnaire (GPAQ - possible scores for physical activity level at work, recreation, or transport: sedentary, moderate, or vigorous). Eating behavior will be examined with the Pennington Biomedical Research Center (PBRC) Impacts of COVID-19 on Dietary Intake survey. Results from linear regression analysis will reveal the relationship between weight status (BMI) and lifestyle (physical activity, eating behavior) and psychological characteristics during the COVID-19 pandemic. Linear regression models will be adjusted for age, gender, month of survey completion, and other demographic characteristics as needed.

2. Correlation between food insecurity, psychosocial factors, and weight status.

   Time frame: March 2021 - September 2021

   Severity of depressive, anxiety, and stress symptoms will be assessed with the 21-item Depression, Anxiety, Stress Scale (DASS-21 - possible scores for symptoms: normal, mild, moderate, severe, extremely severe). The USDA Household Food Sufficiency Questionnaire will be used to calculate food insecurity scores at both the household and the individual level (possible food security levels: high, marginal, low, and very low). The PBRC Impacts of COVID-19 on Sleep survey will assess sleeping behavior. Analysis will generate information on how food insecurity during the pandemic is associated with psychological wellbeing (stress, anxiety, depression), sleeping patterns, degree of acculturation, and weight status. Linear regression models will be used to ascertain the correlation between lifestyle and psychosocial factors with weight status. Models will be adjusted for age, gender, month of survey completion, and other demographic characteristics as appropriate.

3. Role of lifestyle and psychosocial factors in dietary fiber intake.

   Time frame: March 2021 - September 2021

   Intake of fiber-rich foods during the month prior to the data collection date will be assessed using the National Health and Nutrition Examination Survey (NHANES) Dietary Screener. The correlation between fiber intake, food access and insecurity, weight status, and gastrointestinal symptoms will be examined using linear regression models adjusted for age, gender, month of survey completion, and other demographic characteristics as appropriate.

4. Updated New Hampshire (NH) food access database and characterization of barriers to healthy nutrition in NH Hispanics.

   Time frame: October 2021 - March 2022

   Perceived (Perceived Nutrition Environment Survey or NEMS-P) and objective food access (food sources) will be compared to characterize personal and geographical barriers to food access. NH food sources will be aggregated and geo-located using publicly available data from the State of NH (e.g., the USDA Economic Research Service (ERS) Food Access and Food Environment Research Atlases). ArcGIS software will be used to calculate measures of food access and to map sources in conjunction with participants' addresses to inspect for high-level spatial patterning in proximity gaps. For each participant, a count of the food sources can be tallied and constrained to a specified, geographically-dependent radius (e.g., within 1 mile of urban residents, 10 miles of rural residents), used for calculating a binary measure of access (e.g., access within zip code, yes/no), or used for measures of access for exploratory research.

5. Assessment of the physical and psychosocial burden of food insecurity.

   Time frame: March 2021 - March 2022

   A questionnaire assessing health history and sociodemographic characteristics will be administered as well as the Short Acculturation Scale for Hispanics (language acculturation score range=1-6, high=more acculturation). Other health-related constructs include psychological symptoms, sleep patterns, gastrointestinal symptoms, and food insecurity (possible food security levels: high, marginal, low, and very low). Changes in these constructs from baseline to follow-up will be assessed with a dependent t-test for paired samples, and their association with food insecurity through repeated measures ANOVA including only repeat subjects. The cross-sectional correlation between food insecurity and health behavior will be determined through bivariate linear regression models and chi square analyses. Covariate adjustment will include age and sex, and other relevant sociodemographic characteristics.

6. Characterization of the impact of the COVID-19 pandemic on health behaviors and their correlation with food insecurity and weight status.

   Time frame: October 2021 - March 2022

   Food insecurity will be assessed with the USDA Food Sufficiency Questionnaire (possible food security levels: high, marginal, low, and very low). Weighing behaviors will be evaluated with the Early Adult Reduction of weight through Lifestyle intervention (EARLY) Self-Weighing Questionnaire and a modified version of NHANES Weight History Questionnaire. Vaccine receipt will be assessed with questions from the Census Bureau's Household Pulse Survey. COVID-19 vaccination rate will be calculated, and attitudes to vaccination will be analyzed qualitatively through deductive coding. The predictive power of health behaviors on food insecurity and weight status will be assessed by logistic regression. Covariate adjustment will include age and sex.