Department of Anthropology, Northwestern University, Evanston, IL, USA.
Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.
J Nutr. 2021 Jun 1;151(6):1656-1664. doi: 10.1093/jn/nxab030.
Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV.
We aimed to investigate the associations between FI and WI and how they relate to physical and mental health.
Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes.
Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001).
Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.
家庭食物不安全（FI）和水不安全（WI）是普遍存在的公共卫生问题，它们可能同时发生。很少有研究同时评估它们与健康结果的关系，特别是在艾滋病毒感染者中。
我们旨在研究 FI 和 WI 之间的关系以及它们与身心健康的关系。
在肯尼亚西部，我们招募了感染艾滋病毒的小农户成年人参与一项多部门农业和资产贷款干预的集群随机对照试验。我们使用了前一个月（n=716）的 FI（使用家庭食物不安全访问量表，范围：0-27）和 WI（使用专为该地区开发的改良量表，范围：0-51）的经验数据。结果包括前一个月的可能抑郁（使用霍普金斯症状清单）、疲劳和腹泻，以及整体心理健康和身体健康（使用医疗结果研究艾滋病毒健康调查，范围：0-100）。我们首先评估了 FI、WI 与社会人口统计学特征之间的 Pearson 相关性。然后，我们为每个健康结果（对照变量和 FI；对照变量和 WI；对照变量、FI 和 WI）开发了 3 个回归，并比较了模型拟合指标。
家庭 FI、WI 和财富之间的相关性较低，这意味着它们测量了不同的结构。FI 和 WI 与许多身心健康结果有关；同时考虑两种资源不安全通常提供了最佳的模型拟合。例如，当控制 FI 时，每增加 10 分的 WI 评分与身体健康评分降低 6.42 分（P<0.001）和出现可能抑郁的几率增加 2.92 倍（P<0.001）相关。
评估 FI 和 WI 都很重要，因为这有助于正确估计它们与健康结果的关系。针对艾滋病毒感染者的食物和水相关问题的干预措施可能比单一资源不安全的干预措施更有效，从而改善健康。该试验在 clinicaltrials.gov 注册为 NCT02815579。
