The purpose of this study was to preliminarily develop novel self-administered measures to assess nutrition security and choice in dietary characteristics. Measures were piloted in a convenience sample of households at risk for food insecurity in the United States. The survey included the new measures, construct validation variables (household food security, self-reported general health, and dietary variables), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal (Cronbach's alpha (CA)), and construct validity were assessed (Spearman's correlation). Multivariate logistic regression models were used to assess added utility of the new measures beyond food security measurement. Finally, brief screener versions of the full measures were created. Participants in the analytic sample (n = 380) averaged 45 years old, 71% experiencing food insecurity, 42% with high school diploma or less, 78% were women, and racially/ethnically diverse. Scores for the Household Nutrition Security (CA = 0.85; Mean = 2.58 (SD = 0.87)), Household Healthfulness Choice (CA = 0.79; Mean = 2.47 (SD = 0.96)), and Household Dietary Choice (CA = 0.80; Mean = 2.57 (SD = 0.90)) were positively associated with food security (0.401-0.657), general health (0.194-0.290), fruit and vegetable intake frequency (0.240-0.280), and "scratch-cooked" meal intake (0.328-0.350), and negatively associated with "processed" meal intake (-0.162 to -0.234) and an external locus of nutrition control (-0.343 to -0.366). Further, findings show that the new measures are useful for assessing risk for poor dietary and health outcomes even after controlling for household food security status and sample characteristics. These findings are encouraging and support reliability, construct validity, and utility of these new measures. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may be used in various applications to contribute to a better understanding of households' limitations for accessing healthful foods and foods that meet their preferences.

Background: In recent reviews of available measures, no existing measures assessed all four pillars of food security and most only assessed one or two pillars–predominantly the access pillar. The purpose of this study was to preliminarily develop novel measures of availability, utilization, and stability that are complementary to the USDA’s household food security survey measure (HFSSM). Methods: A formative phase included an expert advisory group, literature scans, and interviews with individuals experiencing food insecurity. From April-June 2021, the new measures were piloted in five states (California, Florida, Maryland, North Carolina, and Washington). The cross-sectional pilot survey included the new measures (perceived limited availability, utilization barriers, and food insecurity stability), scales and items for validation (e.g., food security, and self-reported dietary and health outcomes), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal consistency was assessed using Kuder-Richardson formula 21 (KR21), and convergent and discriminant validity were assessed using Spearman’s correlation coefficients. Also, a brief screener version was created for the utilization barriers measure that may be necessary for certain applications (e.g., clinical intake screening to inform referrals to assistance programs). Results: The analytic samples (perceived limited availability (n = 334); utilization barriers (n = 428); food insecurity stability (n = 445)) were around 45 years old on average, most households had children, over two-thirds were food insecure, over three-fourths were women, and the samples were racially/ethnically diverse. All items loaded highly and unambiguously to a factor (factor loadings range 0.525–0.903). Food insecurity stability showed a four-factor structure, utilization barriers showed a two-factor structure, and perceived limited availability showed a two-factor structure. KR21 metrics ranged from 0.72 to 0.84. Higher scores for the new measures were generally associated with increased food insecurity (rhos = 0.248–0.497), except for one of the food insecurity stability scores. Also, several of the measures were associated with statistically significantly worse health and dietary outcomes. Conclusions: The findings support the reliability and construct validity of these new measures within a largely low-income and food insecure sample of households in the United States. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may be used in various applications to promote a more comprehensive understanding of the food insecurity experience. Such work can help inform novel intervention approaches to address food insecurity more fully.

The purpose of this study was to qualitatively explore the per- and poly-fluoroalkyl substances (PFAS) exposure experience and associated stressors, to inform public health efforts to support psychosocial health and resilience in affected communities. Semi-structured interviews (n = 9) were conducted from July–September 2019 with community members and state public health department representatives from areas with PFAS-contaminated drinking water. Thematic analysis was completed and themes were described and summarized. Reported stressors included health concerns and uncertainty, institutional delegitimization and associated distrust, and financial burdens. Interviewees provided several strategies to reduce stress and promote stress coping capacity and resilience, including showing empathy and validating the normalcy of experiencing stress; building trust through visible action and sustained community engagement; providing information and actionable guidance; discussing stress carefully; fostering stress coping capacity and resilience with opportunities to build social capital and restore agency; and building capacity among government agencies and health care providers to address psychosocial stress. While communities affected by PFAS contamination will face unavoidable stressors, positive interactions with government responders and health care providers may help reduce negative stress. More research on how best to integrate community psychosocial health and stress coping and resilience concepts into the public health response to environmental contamination could be helpful in addressing these stressors.

This qualitative study aimed to understand the actions, challenges, and lessons learned for addressing the food and water needs of flood survivors, with a special focus on vulnerable populations and the implications for food security, to inform future disaster response efforts in the U.S. Semi-structured in-depth interviews were conducted from January to August 2020 with the local, state, and national stakeholders (n = 27) involved in the disaster response to the 2019 Nebraska floods, particularly those involved in providing mass care, such as food, water, and shelter, for the flood survivors. The challenge themes were related to limited risk awareness and apathy, the large scope of the impact, the difficulty with coordination and communication, the challenges in risk communication, the limited local-level capacity, and the perceived stigma and fear limiting the utilization of governmental assistance. The mitigation recommendations included the need to consider zoning and infrastructure updates, the implementation of efficient systems that leverage technology for coordination and communication, and guidance on how to address certain human factors. This study reinforces previous findings related to flood disasters and adds to our understanding of disaster response and food insecurity. The practical takeaways from this study can inform future flood-related disaster mitigation approaches in Nebraska and other rural areas.