Psychosocial Factors and Socioeconomic Indicators Are Associated with Household Food Insecurity among Pregnant Women 1

Household food insecurity has been associated with several negative health outcomes, yet little is known about the prevalence and correlates of household food insecurity during pregnancy. This study was conducted as part of the Pregnancy, Infection, and Nutrition prospective cohort study to identify risk factors of preterm birth. The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes # 400% of poverty. Descriptive statistics and logistic regression were used to identify socioeconomic, demographic, and psychosocial predictors of household food insecurity. Among 606 pregnant women, 75% were from fully food-secure, 15% from marginally food-secure, and 10% from food-insecure households. Women from marginally food-secure and food-insecure households had signiﬁcantly less income, less education, and were older than women from fully food-secure households. In bivariate analysis, all psychosocial factors were signiﬁcantly associated with household food insecurity and showed a dose-response relation with increasing food insecurity. Socioeconomic and demographic predictors for household food insecurity were income, black race, and age. After controlling for socioeconomic and demographic variables, psychosocial indicators of perceived stress, trait anxiety, and depressive symptoms, and a locus of control attributed to chance were positively associated with any household food insecurity. Conversely, self-esteem and mastery were inversely associated with any household food insecurity. Psychosocial factors as well as socioeconomic and demographic indicators are associated with household food insecurity among pregnant women; however, the direction of causation between psychosocial indicators and food insecurity cannot be determined in these data. J. Nutr. 136: 177–182, 2006. research 7 of these scales of long-standing characteristics. these 7 affected a household’s food insecurity status. The only episodic CES-D. We used the Z-scores for each psychosocial measure, with a change of 1 SD as the unit of interpretation. Statistical analysis. Descriptive statistics were conducted to test for signiﬁcance between food security status and each of the candidate predictor variables using t tests for the continuous variables of maternal age, number of children and all psychosocial variables, and x 2 tests for the categorical variables of poverty, maternal race, maternal education, and marital status. A x 2 test was also used to test for signiﬁcance between food security status, food coping, and federal food assistance programs. Interactions were tested between categorical variables using a x 2 statistic with a cut-off point for signiﬁcance at P # 0.1; however, no interactions were identiﬁed. Logistic regression models were used to model the predictors of household food security status, controlling for other factors. Two dependent variables were modeled, a combined marginal food secure/food insecure compared with fully food secure and food insecure compared with all others. First, socioeconomic and demographic variables that were assumed exogenous, in other words, variables that would not be caused by household food insecurity status, were modeled as predictors of food security status. Then, due to the high correlation coefﬁcients ( . 0.70) among most psychosocial factors, each psychosocial factor was modeled separately, adjusting for all of the selected socioeconomic variables. Finally, we modeled all socioeconomic and psychosocial variables in a fully adjusted model to identify the joint signiﬁcance of the psychosocial variables on both food security outcomes using a Wald x 2 test. Stata software (41) was used for data management and statistical calculations.