Background: From 2014–2019, Latin America and the Caribbean had the fastest growth of moderate-to-severe food insecurity than any other region, rising from 22.9% to 31.7%. While the prevalence of food insecurity is higher among women than men in every continent, Latin America has the largest food insecurity gender gap. Factors contributing to this gender inequity include underrepresentation of women in formal employment, heightened burden of dependent care on women, and unequal compensation of labor for women vs. men. The objective of this study was to investigate the association between the gender of the head of the household, employment status of household members, and food insecurity in households with children in a low-income district of Lima, Peru. Methods: This cross-sectional study was carried out in Villa El Salvador, the fifth largest district in Metropolitan Lima, Peru, where over 20% of the population lives in poverty. Data were collected on a stratified random sample (n = 329) using a household questionnaire, including a validated food security tool (HFIAS). We ran multivariate logistic regression models predicting household food insecurity, with independent variables including gender of household head, education of household head, employment of household head, household-level employment status, age, and weekly food expenses per person. Results: In fully adjusted models, woman-headed households had almost thrice the odds of being food insecure compared to man-headed households. Education also had a significant effect size: a household whose household head did not complete high school was 3.4 times more likely to be food insecure than if they had some post-secondary education. Woman-headed households had a significantly higher proportion of members not formally employed, compared to man-headed households, but employment status was not associated with food insecurity. Conclusions: Gender of the household head was a major contributing factor to household food insecurity in Villa el Salvador. Gender dynamics affecting opportunities for employment, education, and non-remunerated work should inform national food security policies and interventions with the goal to not only lower food insecurity, but also reduce gender inequities in food insecurity and other nutritional outcomes.

The goal of this study was to measure food insecurity among families with children in a low-income district of Lima, Peru and to identify the formal and informal food resources available to them that may affect their food security status. In June-July 2019, we collected data from 329 randomly selected households in Villa El Salvador (Lima, Peru). Following a mixed methods approach, we found that the percentage of households using food assistance programs (FAPs) increased with increasing levels of food insecurity, but two FAPs were heavily used by households regardless of food (in)security. The main reasons for using FAPs included financial need, already being signed up in the program, and believing that the food was of nutritional value; the main reasons for non-use were finding the program unnecessary, dislike or poor perceived quality of the food, and not being able to sign up for the program. Similarly, informal food resources, such as buying food on credit or receiving food from someone outside the household, were incrementally used with increased levels of food insecurity. Our study clarifies the relationship between level of household food insecurity and FAP use – FAPs more commonly used by food insecure households were used because of financial need, whereas the FAPs most commonly used by food secure households were those with automatic enrollment. At a programmatic level, our research highlights the need for making nutritious and preferred foods available in FAPs and standardizing the application of enrollment criteria.

In Peru, nearly half of children aged 6–36 months were diagnosed with anaemia in 2017. To address this disease, the Peruvian Ministry of Health implemented a national programme in 2014, distributing free micronutrient powders (MNPs) to all children of this age. However, rates of childhood anaemia remain high. The aim of this study was to explore factors at all levels of the Social‐Ecological Model that affect MNP use and adherence in Arequipa, an Andean city with childhood anaemia rates higher than the national average. We conducted in‐depth interviews with 20 health personnel and 24 caregivers and 12 focus group discussions with 105 caregivers. We identified numerous barriers, including negative side effects (constipation, vomiting, and diarrhoea), poor taste of MNP, lack of familial and peer support for its use, insufficient informational resources provided by the health system, and limited human resources that constricted health personnel abilities to implement MNP programming successfully. Facilitators identified included concern about the long‐term effects of anaemia, support from organizations external to the health system, well‐coordinated care within the health system, and provision of resources by the Ministry of Health. We found that community or organizational and societal factors were key to limited MNP use and adherence, specifically the limited time health personnel have to address caregivers' doubts during appointments and the lack of informational resources outside of these appointments. Potential policy implications could be to increase informational resources available outside of individualized counselling by strengthening existing collaborations with community organizations, increasing media coverage, and providing group counselling.

Context: Early age at menarche (AAM) is a risk factor for type 2 diabetes later in life, but the pathogenic pathways that confer increased risk remain unknown. Objective: We examined the associations between AAM and inflammatory and glucose metabolism biomarkers among US adult women who were free of diabetes. Methods: Using the National Health and Nutrition Examination Survey (NHANES) 1999-2018, 19 228 women over 20 years old who were free of self-reported cancer and diabetes were included in this cross-sectional analysis. AAM was the self-reported age at first menstruation. C-reactive protein (CRP), fasting glucose, fasting insulin, and ferritin levels were measured as biomarkers of inflammation and glucose metabolism in adult blood samples using latex-enhanced nephelometry, enzymatic, and immunoassay methods. Multiple linear regression was used to relate AAM to the biomarkers. Results: The median age at the time of blood sample collection was 44 years (interquartile range, 33-62). After age adjustment, there was an association between a lower AAM and higher CRP (P-trend = .006), fasting glucose (P-trend < .0001), fasting insulin (P-trend < .0001), and ferritin (P-trend < .0001). These remained significant after additional adjustment for demographic, reproductive, lifestyle, and adiposity variables, except for ferritin. Smoking modified the effect of AAM on CRP (P-interaction = .014), fasting insulin (P-interaction < .001), and fasting glucose (P-interaction < .001). In stratified analysis, the observed associations became more pronounced in nonsmokers, while they were attenuated to nonsignificance in active smokers. Conclusion: Earlier age at menarche is associated with an unfavorable inflammatory and glucose metabolic biomarker profile in a nationally representative sample of adult women free of diabetes, especially among nonsmokers.

Background: Individual nutrients are associated with cognitive performance, but there is less evidence on the relationship between overall dietary patterns and cognitive performance in midlife. Objective: To examine the relation between dietary patterns and cognitive performance in midlife adults within the Bogalusa Heart Study (BHS). Methods: Cross-sectional data from the 2013–2016 cycle of the Bogalusa Heart Study, a life-course prospective cohort study, were used to generate diet quality scores, including the Alternate Healthy Eating Index 2010 (AHEI), the Healthy Eating Index 2015 (HEI), and the Alternate Mediterranean Dietary Pattern (aMed), based on food frequency questionnaires. Cognitive scores assessing attention and processing, episodic memory, and executive function were generated through validated cognitive tests. Generalized linear and logistic regression models were fit with adjustment for potential confounders. Results: Of 1053 participants included in the analysis, the mean age was 48.18 (SD = 5.22) years; 38.94% were male; and 31.14% identified as Black. Higher diet quality scores were associated with a higher global cognitive score (P-trend = 0.01 for AHEI, 0.02 for HEI, and 0.04 for aMed) after adjusting for age, sex, race, employment, education, smoking status, total energy intake, physical activity, BMI, diabetes, and hypertension. In dichotomous outcome analyses, higher AHEI and aMed scores remained inversely associated with low cognition when adjusting for similar covariates (P-trend = 0.03 for AHEI, 0.03 for aMed), but the association was attenuated to non-significance for HEI. In joint effect analysis between employment and dietary patterns (P-interaction = 0.28 for AHEI, 0.01 for HEI, and 0.11 for aMed), unemployment with a lower quality diet was associated with lower cognitive performance (P-trend = 0.02 for AHEI, 0.02 for HEI, and 0.01 for aMed). Conclusions: A high-quality diet is associated with optimal cognitive performance among midlife adults, and unemployment status may influence this association. These findings suggest that dietary interventions during midlife may represent a public health strategy to preserve cognitive function and reduce future neurodegenerative disease burden, especially in disadvantaged populations.

This chapter proposes that the recent turn toward critical consciousness in dual language bilingual education (DLBE) and related fields warrants examination of the role of Black leadership in decentering whiteness in DLBE. The case narrative depicts how a Black principal engaged in efforts to disrupt whiteness in a French language open-enrollment charter school, and the challenges encountered. While research on the impact of Black leadership in DLBE remains limited, this chapter begins the work of filling this gap by highlighting the pivotal role that Black leadership plays in cultivating belongingness among Black youth and advancing antiracist practices in DLBE. We argue that because Black school leaders are fundamental to driving equity efforts, they serve as a critical antidote to white supremacy culture. Strategies to activate critical consciousness in DLBE must therefore include deliberate policies and practices to debias talent and hire, promote, and retain Black leadership.