Food insecurity in Dutch disadvantaged neighbourhoods: a socio-ecological approach

Abstract

Food insecurity is an important public health concern; however, research into this phenomenon within the Netherlands is limited. Food insecurity is not solely related to individual factors, but can also be influenced by various factors in the social and physical environment. Therefore, this study aimed to identify determinants of food insecurity within the personal, social and physical environment, based on the social ecological model (SEM), and to identify their relative importance for experiencing food insecurity. The study population consisted of 307 participants living in disadvantaged neighbourhoods of the Dutch city The Hague, of which approximately one-quarter were food insecure. Participant characteristics showing bivariate associations P < 0⋅20 were placed in a predetermined level of the SEM, after which a multivariate logistic regression was performed for each level and the Nagelkerke pseudo R ² was presented. Determinants of food insecurity were BMI, gross monthly income, highest educational attainment, smoking status, diet quality, employment status, marital status and religion (P < 0⋅05). The results showed that 29⋅7 % of the total variance in food insecurity status was explained by all included determinants together. The personal, social and physical environment explained 20⋅6, 14⋅0 and 2⋅4 % of the total variance, respectively. Our findings suggest that determinants within the personal environment are most important for explaining differences in experienced food insecurity. The present study contributes to furthering the knowledge about the relative importance of the personal, social and physical environment, indicating that determinants within the personal environment may be most promising for developing targeted interventions to reduce food insecurity.

Keywords: BMI, body mass index; DHC, Dutch Health Council; Determinants; Explained variance; FFQ, food frequency questionnaire; FI, food insecure; FS, food secure; Food insecurity; Food security; IQR, interquartile range; ISCED, International Standard Classification of Education; LUMC, Leiden University Medical Center; MAR, missing at random; MCS, mental component summary; MI, multiple imputation; NNC, Netherlands Nutrition Center; PCS, physical component summary; SEM, social ecological model; SEP, socio-economic position; SF-12, 12-Item Short Form Health Survey; SNAP, Supplement Nutrition and Assistance Program; Social ecological model; USDA, United States Department of Agriculture; WMO, ‘Wet medisch-wetenschappelijk onderzoek’, in English: Medical Research Involving Human Subjects Act.