Background Zip codes classified by the Food Insecurity Index with moderate and high food insecurity (FI) risk can be a threat to the health and well-being of children during the first 1,000 days ...(from pregnancy to 2 years). The presence of nurturing care assets (i.e., stable environments that promote health and nutrition, learning opportunities, security and safety, and responsive relationships) can contribute to supporting families and their communities, and ultimately reduce systemic barriers to food security. We aimed to identify and characterize nurturing care assets in under-resourced communities with moderate and high FI risk. Methods Four steps were used to conduct a Community Asset Mapping (CAM): (1) review of community documents across five zip codes in Clark County, Nevada (2), engagement of community members in identifying community assets (3), definition of the assets providing nurturing care services, and (4) classification of assets to nurturing care components, i.e., good health, adequate nutrition, safety and security, opportunities for early learning, and responsive caregiving. The Food Insecurity Index was used to determine FI risk in each zip code. Analyses explored whether disparities in nurturing care assets across zip codes with moderate and high FI exist. Results We identified 353 nurturing care assets across zip codes. A more significant number of nurturing care assets were present in zip codes with high FI risk. The adequate nutrition component had the most assets overall (n = 218, 61.8%), while the responsive caregiving category had the least (n = 26, 7.4%). Most of the adequate nutrition resources consisted of convenience stores (n = 96), food pantries (n = 33), and grocery stores (n = 33). Disparities in the number and type of good health, early learning, and security and safety assets were identified within zip codes with high FI risk compared to moderate FI risk. Conclusions The quantity and type of nurturing care assets can exacerbate existing demographic disparities across zip codes, which are tied to barriers to access to food in under-resourced communities in Clark County, Nevada. Co-creating a nurturing care asset-based zip code strategy to address high FI risk will require strengthening systems across existing nurturing care assets. Keywords: Community asset mapping, Food security, Maternal-child health, Nutrition
Abstract Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food insecurity (HFI) is ...associated with exclusive and continued breastfeeding (EBF and CBF) as recommended by the World Health Organization/United Nations Children's Fund (UNICEF) Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis, literature searches using ‘breastfeeding’, ‘food insecurity’ and ‘infant’ terms were conducted in PubMed/MEDLINE, Embase, CINAHL, Global Health and LILACS from inception through November 2023, without language restrictions, yielding 1382 publications (PROSPERO:CRD42022329836). Predetermined eligibility criteria yielded the 12 included studies (nine cross‐sectional and three cohorts). The risk of bias was assessed through the Effective Public Health Practice Project. Meta‐analysis was performed for studies assessing EBF ( n = 10), and metaregression was used to explore heterogeneity across studies. Prevalence of EBF ranged from 1.6% to 85.3%, with a lower prevalence among HFI. The pooled effect of the association between HFI and EBF presented an odds ratio (OR) of 0.61 (95% CI = 0.49–0.76) with consistent results across marginal (OR = 0.72, 95% CI = 0.55–0.94), moderate (OR = 0.59, 95% CI = 0.41–0.84) and severe HFI (OR = 0.49, 95% CI = 0.32–0.76). High heterogeneity was found only when HFI was dichotomized. The prevalence of CBF ranged from 35.4% to 78.0%, with inconsistent prevalence among HFI; a meta‐analysis was not performed due to the low number of studies ( n = 3). We concluded that HFI levels are associated with lower odds of EBF. Integrating service and policy‐level strategies, such as screening, referrals, skilled breastfeeding counseling and access to comprehensive nutrition and social programs, could reduce structural inequities and promote adherence to the World Health Organization/UNICEF breastfeeding recommendations among food‐insecure families.
Key messages Breastfeeding, particularly exclusive breastfeeding (EBF), could be a strategy to protect socially and economically vulnerable infants from household food insecurity (HFI). However, inequities in breastfeeding practices can be amplified by structural barriers contributing to HFI, such as limited access to food, lack of or unstable employment, financial constraints and limited access to health care. Evidence from quantitative and qualitative studies investigating the impact of HFI on exclusive and continued breastfeeding (CBF) practices across different geocultural contexts have found inconsistent results. Our study found that HFI levels are associated with lower EBF practices; high heterogeneity was present only when HFI was dichotomized. Associations with CBF practices could not be assessed due to the low number of studies. A bundle of service and policy‐level strategies, such as universal screening, timely referrals to address the structural causes of HFI, culturally appropriated skilled breastfeeding counseling and access to comprehensive nutrition and social programs, could reduce structural inequities and promote adherence to the World Health Organization/United Nations Children's Fund breastfeeding recommendations among food‐insecure families.
