TY - JOUR
T1 - Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya
AU - Miller, Joshua D.
AU - Frongillo, Edward A.
AU - Weke, Elly
AU - Burger, Rachel
AU - Wekesa, Pauline
AU - Sheira, Lila A.
AU - A Rain Mocello, Rain Mocello
AU - Bukusi, Elizabeth A.
AU - Otieno, Phelgona
AU - Cohen, Craig R.
AU - Weiser, Sheri D.
AU - Young, Sera L.
N1 - Funding Information:
We acknowledge the important support of the Kenyan Medical Research Institute (KEMRI) and the University of California, San Francisco. We also recognize the Director of KEMRI, the Director of KEMRI's Centre for Microbiology Research, and the Kisumu, Homa Bay, and Migori County Ministries of Health for their support in conducting this research. We acknowledge the content expertise and support received from the University of California Global Health Institute's Center of Expertise in Women's Health and Empowerment. We also thank Bernard Rono, Brian Polo, Phoebe Olugo, Sylvia Atieno, Maureen Nyaura, Sylvia Akoko, Titus Arunga, Belinda Odhiambo, Richard Omondi, Elly Bwana, Emmanuel Otieno, Julie Omoro, Doreen Otieno, Rose Ngwengi, Amos Onyango, Sharon Owour, Pius Atonga, Fredrick Ouko, Nicholas Ambira, George Kennedy, Geoffery Ojuok, Risper Omollo, Elija Mbaja, Valiant Odhiambo, Peter Obando, and Julias Odhacha for their important contributions to this research. The authors' responsibilities were as follows-EAB, PO, CRC, SDW, and SLY: conceived, designed, and directed the study; RB, EW, and PW: oversaw project activities and data collection; LAS and ARM: cleaned and managed the data; JDM and EAF: led data analysis; JDM: wrote the first draft of the manuscript; and all authors: critically reviewed the manuscript, provided feedback, and read and approved the final manuscript
Publisher Copyright:
© 2021 Oxford University Press. All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can cooccur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. Objectives: We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Methods: Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100).We first assessed Pearson correlations between FI,WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Results: Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI andWI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). Conclusions: Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. The Author(s) 2021.
AB - Background: Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can cooccur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. Objectives: We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Methods: Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100).We first assessed Pearson correlations between FI,WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Results: Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI andWI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). Conclusions: Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. The Author(s) 2021.
KW - diarrhea
KW - fatigue
KW - mental and physical health
KW - probable depression
KW - resource insecurity
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U2 - 10.1093/jn/nxab030
DO - 10.1093/jn/nxab030
M3 - Article
C2 - 33709134
AN - SCOPUS:85107710946
SN - 0022-3166
VL - 151
SP - 1656
EP - 1664
JO - Journal of Nutrition
JF - Journal of Nutrition
IS - 6
ER -
