Concordance in reports of food insecurity associated with environmental factors among Latino fathers and mothers


 Background: Food assistance and nutrition education are strategies used to address the high prevalence of food insecurity among U.S. Latino households. Assessment of food security status is necessary to implement these strategies. However, similarities and differences in perceptions of food security status have not been reported among Latino fathers and mothers who may have different home food acquisition and preparation responsibilities. This study aimed to 1) determine demographic characteristics and/or food-related factors associated with perceptions of food security status among Latino fathers and mothers, and 2) identify those factors correlated with concordance in perceptions of food insecurity between fathers and mothers.Methods: Baseline data were used from a Latino-family, community-based program to improve paternal parenting practices and youth energy balance-related behaviors (Padres Preparados, Jóvenes Saludables), including 106 father and mother couples. Food security was assessed with two questions from the U.S. Department of Agriculture 18-item Household Food Security Survey. Logistic regression models were used to evaluate associations between food security and predictor variables in fathers or mothers and between couple discordant responses in food security status and predictor variables.Results: The prevalence of household food insecurity was reported by 39% of fathers and 55% of mothers. Food security status was associated with neighborhood safety (odds ratio (OR): 3.7, p < 0.05) and household income (OR: 3.2, p < 0.05) in fathers, and with neighborhood safety (OR: 4.1, p < 0.01) and home fruit and vegetable availability (OR: 5.5, p < 0.01) in mothers. Couple discordance in reporting food security status occurred in 24% of the couples and was related to higher discordance among couples where fathers reported a lower frequency of participation in nutrition education than mothers (OR: 3.4, p < 0.05) and different perceptions of home fruit and vegetable accessibility (OR: 3.1, p < 0.05).Conclusions: Among Latino fathers and/or mothers, factors associated with perceptions of food insecurity differed, possibly related to fathers versus mothers having access to information about different household aspects related to food insecurity. Nutrition education for fathers may support an improvement in couple discordance in assessment of food security.


Background
The reported prevalence of food insecurity among Hispanic households in the U.S. based on 2011-2014 data from the Current Population Survey's Food Security Supplement was 22.4%, which was higher than the 14% prevalence reported for U.S. households overall [1] and signi cantly increased from 1999-2000 to 2015-2016 based on National Health and Nutrition Examination Survey (NHANES) data [2]. Food insecurity is an important issue for Latino youth and adults, because of associations with inadequate nutrient intake [3][4][5][6], under-consumption of healthy foods [6], and a high prevalence of obesity [7][8][9].
Latinos play a signi cant role in the U.S. economy accounting for 17% of the labor force [10], often working several jobs to attain nancial gains. Income and other social determinants of health such as lack of access to jobs, inadequate transportation and wages, and inequities in assets and wealth may contribute to the disproportionately high rates of food insecurity among Latinos. Eligible immigrant families, in particular, may not access food assistance to address food insecurity because of immigration policy changes and enforcement activities. Community-driven strategies including food assistance and nutrition education have been used to address food insecurity leading to positive outcomes regarding food security status [11][12][13].
Previous studies with Latino youth and adults as well as those of other racial/ethnic groups have identi ed a variety of factors in uencing household food insecurity. These include demographic characteristics such as sex, marital status, education attainment, and acculturation [1,14], economic characteristics such as household income and employment status [1,14], home food environment factors including social support from family members, home food availability, and home food accessibility [15][16][17], and environmental factors such as neighborhood safety and geographic location [1,7,18]. In addition to clarifying factors associated with food security status among Latino families, accurate assessment of food security status, including the measurement of individual food security status [19,20] is also key for planning food assistance and nutrition education.
Food security status, de ned as access to enough food for an active, healthy life [19], has frequently been assessed for households and treated as a representative score for the household [21]. However, some studies indicated that females reported higher food insecurity than males [22][23][24]. Higher food insecurity in female-led versus male-led households was attributed to women's socio-economic disadvantages in female-led households, such as lower income or more dependents [23]. Differences in measurement of food insecurity between mother and father pairs in a qualitative study were based on different interpretations of terms such as "household", "balanced meal", and "worry" used in questions to assess food insecurity [14]. Within male and female couples in the same household in Bangladesh, discordant responses to food security questionnaires were observed in 19% of couples [25]. In other studies, couple discordance has also been reported for additional diverse household and individual characteristics such as income, marital length, risk preference, and social preferences [26,27]. To assess food security status of Latino households, differences in responses between fathers and mothers should be examined along with factors associated with these differences. To date, sex differences and couple discordance in reporting food security status have not been reported among Latino fathers and mothers.
The purpose of this study was to 1) determine demographic characteristics and/or food-related factors associated with perceptions of food insecurity status among Latino fathers and mothers, and 2) identify those factors correlated with concordance in perceptions of food insecurity between fathers and mothers.

Design and Setting
The current study used cross-sectional baseline data from a community-based intervention program to improve paternal parenting practices and youth energy balance-related behaviors (Padres Preparados, Jóvenes Saludables) [28]. Latino fathers or male caregivers (hereafter referred to as fathers) and early adolescents (10-14 years) were the primary research participants, however mothers or female caregivers (hereafter referred to as mothers) were also invited to attend educational sessions and complete evaluation data collection procedures as part of the intervention. Baseline data collection occurred from 2017 to 2020 at three churches and two Latino-serving non-pro t community centers in the Minneapolis/St. Paul metropolitan area.

Participants
Participants were recruited using yers, word of mouth, and announcements at community events. Eligibility criteria for fathers included self-identifying as Latino, speaking Spanish, and having meals with their early adolescent child at least three times in a week. Mothers self-identi ed as speaking Spanish and as spouses/partners of fathers who were parents of the youth participants. Three hundred sixty-nine families were interested in the Padres Preparados, Jóvenes Saludables study, and 277 families remained after screening for eligibility. Baseline data were analyzed in the current study from 106 father and mother couples who completed food security questions. All questionnaires were completed in Spanish.
Fathers received cash compensation ($35) for participating in baseline data collection procedures. Fathers and mothers provided consent prior to participation. The study was approved by the University of Minnesota Institutional Review Board.

Anthropometric measures
Trained researchers measured body weight and height of fathers and mothers using a digital scale (BWB-800 Scale, Tanita) and a stadiometer based on standard procedures [29]. Measurements were completed twice to the nearest 0.1 kg weight and 0.1 cm for height. Body mass index (BMI) was calculated using the average weight and height (kg/m 2 ).

Sociodemographic characteristics
Fathers and mothers individually reported their age, educational attainment, employment status, household income, number of years in the U.S., language spoken at home, and marital status. Age, educational attainment, employment status, and household income were dichotomized as < median age vs. ≥ median age, < high school vs. ≥ high school, full-time/self-employed vs. part-time/not-employed, household income < $25,000 vs. ≥ $25,000. Acculturation level was based on the number of years in the U.S. (<10 years, ≥10 and <20, ≥20 and <30, ≥30) and language spoken at home (only native, more native language than English, English equal to native language, only English, or more English than native language), which were combined and categorized as low, middle, or high acculturation levels [30].

Food security
Food security was assessed based on two questions in Spanish from the US Department of Agriculture 18-item Household Food Security Survey. The two questions were "Within the past 12 months, we worried about whether our food would run out before we got money to buy more" and "Within the past 12 months, the food we bought just didn't last and we didn't have money to get more", with response options of often true or sometimes true vs. never true. Hager et al. reported that an a rmative response (often true or sometimes true) to at least one of these two questions showed 97% sensitivity and 83% speci city for detection of household food insecurity [31].

Physical home food environment
Questions about home food availability and accessibility were adapted from a previous cross-sectional study of adolescents (Project EAT -Eating Among Teens) [32]. Home food availability was assessed by summing coded responses to six questions regarding availability of fruits, vegetables, junk foods, soda pop, sweets, and potato chips (never = 1, sometimes = 2, usually = 3, always = 4) [32,33]. Scores for fruit and vegetable (FV) availability were the sum of the coded responses to the questions about availability of fruits and vegetables. Home FV accessibility was assessed by summing coded responses for three questions regarding accessibility of FV (never = 0, sometimes = 1, usually = 2, always = 3) [32,34]. Summed coded responses were dichotomized as < median value vs. ≥ median value.

Food-related activities and responsibilities
A variable regarding frequency of food-related activities with their child was based on four questions with coded response options; one assessed family meal frequency adapted from Project EAT [35] and the other three assessed frequency of food-related activities with their child adapted from Musher-Eizenman and Holub (2007) [36]. These included family meal frequency (never = 0, 1-2 times = 1, 3-4 times = 2, 5-6 times = 3, 7 times = 4, >7 times = 5) [35] and frequency of three food-related activities with their child (planning meals, buying foods, preparing foods -almost never or never = 1, rarely = 2, sometimes = 3, most of time = 4, almost always or always = 5) [36]. Questions assessing parents' responsibilities for feeding their child were adapted from Mallan et al. (2013) [37]. Five questions addressed feeding responsibilities, including responsibilities for planning meals, buying foods, preparing meals, making decisions about, and controlling what the child eats. Coded response options were almost never or never = 1, rarely = 2, half of the time = 3, most of the time = 4 and almost always or always = 5. The sum of the coded response options for food-related activities with the child and feeding responsibilities were dichotomized as < median value vs. ≥ median value.

Environmental factors
Neighborhood safety was assessed based on agreement with two questions adapted from Bennett et al. (2007) [38] regarding perceptions of whether the crime rate makes walking in their neighborhood unsafe during the day and at night (strongly disagree = 1 to strongly agree = 4). Family stress was assessed using three questions about the importance of family relations, con ict between personal and family goals, and individualism among family members (not at all worried = 1 to extremely worried = 5) [39].
These variables were represented by the sums of the coded responses, dichotomized as < median value vs. ≥ median value.

Statistical Analysis
Demographic data were described using means and standard deviations (mean ± SD) or frequencies for categories for fathers and mothers. To determine the differences in demographic characteristics between fathers and mothers, t-test or Fisher's exact tests were conducted.
Associations between food security and predictor variables were examined among fathers and mothers separately using three logistic regression models. Preliminary analyses were conducted to assess appropriateness of variables for inclusion in regression models, including Fisher's exact tests to determine differences in sociodemographic characteristics, participation in food assistance programs, physical home food environment, food-related activities and responsibilities, and environmental factors by food security status. In the logistic regression models, food security status served as the dependent variable and appropriate covariates were included as independent variables based on the preliminary analyses and tests for multicollinearity. Neighborhood safety was included in model 1 for both fathers and mothers. Household income and participation in food assistance programs were additionally entered into model 2 for fathers, while home FV availability and family stress were entered into model 2 for mothers. All these ve variables were entered in model 3 for both fathers and mothers.
A cross-tabulation of household food security, as reported by fathers and mothers, was examined to evaluate concordance within couples using Fisher's exact test. Father and mother couples were dichotomized into perceived concordance or discordance in food security status. Concordance was de ned as couples where both the father and mother reported food security status or both the father and mother reported food insecurity status. The predictors for couple concordance in reports of food security status were determined using concordance or discordance with distinct characteristics of the variables within couples. Logistic regression analysis was used to evaluate the predictors for discordance in reports of food security within couples. Fisher's exact tests were used to determine appropriateness of covariates for inclusion in the logistic regression model. The level of signi cance was set at p<0.05. Statistical analysis was performed using R version 3.5.1 and SPSS for Windows, version 26.

Participant characteristics
Similarities among fathers and mothers were observed regarding education level and household income ( Table 1). About one-third had less than a high school education and about one-half had a household income less than $25,000. Signi cant differences were observed between fathers and mothers in age (fathers were slightly older than mothers), BMI (mothers had slightly higher BMIs than fathers), employment status (more fathers were employed full time than mothers), and acculturation (more mothers had lower acculturation levels than fathers) (all p < 0.01) ( Table 1). Of participants, 93% of fathers and 91% of mothers reported being married.
Approximately half of participants reported being food insecure (39% for fathers and 55% for mothers) with signi cantly more mothers than fathers reporting food insecurity (p < 0.05) ( Table 1). The majority of couples reported concordant food security or insecurity status (76% of couples, n = 81), while reports from 25 couples were discordant. In the couples who reported concordant food security status, 44 couples reported food security, and 37 couples reported insecurity. In the couples who reported discordant food security status, 21 mothers reported food insecurity status while fathers did not and four fathers reported food insecurity status while mothers did not. The number of both mothers and fathers perceiving their neighborhood to be safe vs. unsafe differed by reports of food security or insecurity status (Table 2). Household income, participation in food assistance programs, and responsibilities for feeding activities differed signi cantly between fathers who reported food security and food insecurity (p < 0.05). Home FV availability and family stress differed between mothers who reported food security vs. food insecurity ( Table 2). After assessment for multicollinearity, neighborhood safety, household income, participation in food assistance programs, home FV availability, and family stress were included as covariates in the logistic regression models (Table 3). Among fathers and mothers, logistic regression models showed that food insecurity was associated with perceptions that the neighborhood was unsafe (Table 3). Food insecurity was associated with less household income in models 2 and 3 among fathers. Compared with fathers who reported food security, fathers who perceived an unsafe neighborhood and lower household income were 3.7 and 3.2 times more likely to report food insecurity after controlling for covariates in model 3, respectively (odds ratio (    Table 2 Frequency of food security status by predictor variables (106 Latino fathers and mothers) Table 2 is larger than 1 page and placed at the end of the document with the legend. Table 3 Associations between food insecurity status and household environmental factors (106 Latino fathers and mothers) Table 3 is larger than 1 page and placed at the end of the document with the legend.
Factors associated with couple discordance in reporting food security status Differences within couples in reported acculturation level, participation in nutrition education, home food availability, and home FV accessibility tended to be associated with couple discordance in reporting food security status compared with other variables (p < 0.1) (   Table 4 Frequency of concordance/discordance in couple-reported food security by concordance/discordance in predictor variables (106 Latino couples) Table 4 is larger than 1 page and placed at the end of the document with the legend.

Discussion
The prevalence of household food insecurity was reported more often by Latina mothers compared with Latino fathers. Food security status was associated with neighborhood safety in both fathers and mothers, and with household income and home FV availability in fathers and mothers, respectively.
Couple discordance in reporting food security status occurred in 24% of the couples and was related to couple differences in reported frequencies of participation in nutrition education and perceived home FV accessibility.
The association between neighborhood safety and food insecurity was observed in mothers and fathers, providing evidence that the previous relationship observed between neighborhood safety and food insecurity among females [18] was also observed among males. Beliefs about neighborhood safety based on threats of crime or violence may increase perceptions of the di culty of accessing resources [40], including those that in uence food security such as community gardens, food pantries, or discount grocery stores. Therefore, in the current study, a perceived lack of neighborhood safety among both fathers and mothers may have been considered a barrier to accessing food resources, which contributed to assessment of food insecurity.
Household income is a well-known variable associated with food security status among both males and females [4,23,41]. The current study showed that low household income was related to food insecurity reported only by fathers within couples, therefore fathers may have more responsibility for household income as a primary earner or mothers may have less income information to consider [23,42].
Low home FV availability was related to food insecurity only in mothers. This nding is consistent with two prior studies, one which observed a signi cant association between food insecurity and healthy food availability among a study population which was 86% female [16], and another which reported that food insecurity was associated with home FV availability among females [43]. Compared with fathers, mothers may be more aware of FV prices, which are generally more expensive than foods of lower nutritional value [44]. Mothers may also be more aware of the supply of FV at home based on meal planning and food preparation responsibilities, therefore more aware of how household food security status is related to home food availability than fathers. While fathers and mothers would share information about neighborhood safety, they might have different information related to foods, resulting in different factors associated with food security status.
Couple discordance in reporting food security status was associated with discordance in reporting two variables, participation in nutrition education and home FV accessibility. Discordance in reporting participation in nutrition education may be based on a disproportionate participation ratio in the programs among fathers and mothers. Of fathers, 45 participants had never participated in nutrition education compared to 29 mothers (Table 2). Participation in SNAP and SNAP education were related to improvement in recipients' food security status in other studies [12,13]. Therefore, participation among fathers in such programs may provide fathers with resource management skills to stretch food dollars and reduce concerns for nancial issues, resulting in an increased number of couples concordant in reported food security status as well as improvement in food security.
Concordance in reporting home FV accessibility was associated with concordance in food security status. Accessibility may provide visible reminders of FV availability to both fathers and mothers and support their common recognition of food security. Previous studies involving primarily White women and [45] and Black, White and Hispanic women [17] reported an association between home food accessibility and food security, while the current study did not show an association between FV accessibility and food security among Latino fathers or mothers. The relationship between home food security and home food accessibility needs to be studied further by sex, healthfulness of foods being assessed for accessibility, and locations at home.
This study contained four main limitations. First, low-income participants were recruited in a limited geographic area, which may not represent the Latino population in the U.S. Because the current participants were interested in a community-based intervention program to improve energy balancerelated behaviors of their child, they may have experienced di culty feeding their child healthy foods based on food availability. Therefore, the prevalence of food insecurity in participants may have been higher than in other Latino populations. Second, participation in food assistance programs re ected selfreported attendance of fathers and mothers and did not consider eligibility for these programs. Third, this cross-sectional study did not show causal relationships. Further studies are needed to clarify whether associated factors affect food security status. Finally, the length of marriage was not considered, although there was some discordance regarding responses to this variable among couples in another study [26]. This characteristic might in uence how the concept of household food security is shared and agreed upon within couples.

Conclusions
Among Latino fathers and mothers, three factors were associated with food security including neighborhood safety in both fathers and mothers, household income only in fathers, and home FV availability only in mothers. Differences in associated factors may be dependent on fathers vs. mothers having access to information about different household aspects related to food insecurity. Couple discordance in reporting food security status was related to couple differences in frequencies of participation in nutrition education and perceptions of home FV accessibility. Nutrition education for fathers may support an improvement in couple discordance in assessment of food security. Availability of data and materials The data used in the current study are available from the corresponding author on reasonable request.

Competing interests
The authors declare that they have no competing interests.

Funding
This project was supported by the Agriculture and Food Research Initiative (Grant no. 2016-68001-24921) from the USDA National Institute of Food and Agriculture. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.