Edward A. Frongillo

Background: Global water monitoring has primarily focused on resource-side indicators such as physical water availability and service provision. The 12-item Individual Water Insecurity Experiences (IWISE) Scale is a user-side measure of whether individuals are meeting their basic water needs. As use has grown beyond the countries where it was originally validated, we assessed its reliability, validity, and cross-country equivalence across countries spanning all World Bank income groups. To provide global benchmarks, we estimated the prevalence of and disparities in water insecurity.Methods: We pooled nationally representative Gallup World Poll data from 2020, 2022, and 2025 for 89,740 adults in 76 countries. Internal consistency was assessed with Cronbach’s alpha, construct validity with modified Poisson regression of dissatisfaction with local water quality on water insecurity, and measurement equivalence with multigroup confirmatory factor analysis and alignment optimization. We estimated country-level prevalences of each water insecurity category and within-country differences in moderate-to-high water insecurity (IWISE ≥12) by gender, education, urbanicity, and household income.Findings: Internal consistency was high (α ≥0·80 in 74 of 76 countries). Higher IWISE scores were associated with greater dissatisfaction with local water quality in every country (prevalence ratios 1·02–1·22). Configural and metric invariance held; scalar invariance was approximate, with 96% of loadings and 72% of thresholds equivalent across countries. The prevalence of moderate-to-high water insecurity ranged from 0·4% (Cambodia) to 66·3% (Chad); low water insecurity was widespread (4·7–43·3%). Disparities were most consistent for household income (the lowest quintile had a higher prevalence in 72 of 75 countries) and education; they varied in direction by gender and urbanicity.Interpretation: The IWISE Scale is a reliable, valid, and approximately equivalent measure of individual water insecurity across country-income levels. It complements resource-based indicators and reveals disparities within and across countries to inform equity-focused policy and practice.

Objectives: Estimate the prevalence and sociodemographic correlates of adolescent-reported food insecurity experiences from 2019-2021. Methods: Repeat cross-sectional data were collected in November-December 2019, 2020, and 2021 from adolescents aged 10-17 years living in the ten Canadian provinces (n = 11,057). The prevalence of ten items and five food insecurity subconstructs based on the 10-item Child Food Insecurity Experiences Scale was estimated. Weighted multinomial logistic regression assessed associations between sociodemographic characteristics and food insecurity experiences as a four-level ( no , few , several , or many experiences) variable. Results: Across 2019-2021 among adolescents, the prevalence of worrying about food scarcity ranged between 18.4%-22.5%, worrying about parental/guardian ability to get food ranged between 22.8%-26.9%, and not being able to get the food they wanted ranged between 23.5%-26.1%. Close to or above one in four adolescents affirmed the uncertainty (range: 26.9%-29.9%) and compromised diet quality or preferences (range: 23.5%-26.1%) subconstructs. In 2021, adolescents identifying as Black had a higher relative risk ratio of few food insecurity experiences (adjusted relative risk ratio (ARRR): 2.04 [95% CI: 1.20, 3.47], p-value: several food insecurity experiences (2.38 [1.10, 5.15], p-value 0.03) compared to adolescents identifying as White. The relative risk ratio of having few , several , or many food insecurity experiences also differed by age, sex-at-birth, perceived income adequacy, and region. Conclusion: The type and number of experiences reported underscores the value of directly measuring food insecurity. Interventions to mitigate food insecurity’s adverse consequences are warranted.

Introduction: Interventions that address household-level factors, including food insecurity (FI) and poverty, may reduce HIV risk and improve sexual and reproductive health (SRH) among adolescent girls and young women (AGYW). Methods: This cluster randomised controlled trial in Kenya assessed AGYW living in households of adults enrolled in Shamba Maisha (SM). SM was a multisectoral agricultural livelihood intervention designed to improve HIV health. At the trial end, we used linear and logistic regressions to compare differences between the intervention and control arms in FI, and mental health among AGYW-caregiver pairs and SRH outcomes among the AGYW, accounting for clusters with robust standard errors. We also conducted a secondary analysis among 15–19 years whose caregivers were SM participants. Results: The study enrolled 241 AGYW-caregiver pairs (n=131 intervention). The median age of AGYW was 15 years old (IQR: 14–17 years old). At endline, AGYW in intervention households had less FI (OR: 0.45, 95% CI 0.21 to 0.97; p=0.04), lower depressive symptomatology (OR: 0.53; 95% CI 0.24 to 1.15, p=0.11) and no difference in unprotected sex (OR: 1.16; 95% CI 0.63 to 2.16; p=0.63) compared with those in control households. In the secondary analysis, intervention AGYW had higher body mass index (β: 1.25; SE: 0.32; p=0.002), fewer symptoms of depression (OR: 0.42; 95% CI 0.21 to 0.84; p=0.01) and anxiety (OR: 0.23, 95% CI 0.05 to 1.11; p=0.07), and less sexual intimate partner violence (IPV) (OR: 0.28; 95% CI 0.08 to 0.91; p=0.03) than control AGYW. Intervention arm caregivers had less FI than those in the control arm (OR: 0.05; 95% CI 0.0047 to 0.54; p=0.014). Conclusions: An agricultural livelihood intervention among adults living with HIV improved FI, mental health and IPV outcomes among AGYW in their households. These findings will guide the scale-up of an agricultural livelihood intervention for HIV-affected households with AGYW in sub-Saharan Africa. Trial registration number: NCT03741634 .

Healthy food choices are increasingly understood to be shaped by the everyday interactions between people and their environment. However, current efforts to monitor dynamic food environments in low- and middle-income countries are limited by a lack of globally applicable, context-specific measures that holistically capture diverse lived experiences within the same location. To address this, we utilise expert consultations and cognitive testing to develop the Multidimensional Food Environment Experience Questionnaire (MFEEQ) and corresponding Metric (MFEEM), constructed using the Alkire-Foster multidimensional framework, to quantify the favourability of local food environment experiences for the acquisition of healthy foods. The questionnaire was administered over two rounds to 1661 households in Hyderabad (India), East Lombok (Indonesia), and Kaffrine (Senegal), and evaluated for internal coherence, directional consistency and outcome sensitivity. The metric enables simultaneous comparison across eight food environment dimensions, spanning external and personal domains, multiple foods, seasons and geographical contexts (i.e., urban, peri-urban and rural settings). Results show that whilst dark-green leafy vegetables and chicken meat and organs are both socio-culturally desirable and convenient to acquire and prepare across all three study sites, common barriers relating to their lack of availability, affordability, hygiene, and limited promotional information persist. Food environment experiences are further found to be seasonally variable and spatially clustered, highlighting key opportunities for policymakers to target interventions towards specific times and locations. By operationalising a novel multidimensional metric, this study demonstrates the need to incorporate lived experiences into the measurement and monitoring of food environments to help create equitable food systems for all.

Suaahara was a USAID‐funded multi‐sectoral integrated nutrition program that aimed to improve the nutritional status of children under the age of five and their mothers in Nepal. The program included multiple interventions targeted to mothers and children, as well as other caregivers. Caregiver knowledge of optimal nutrition and health practices among household members is an important driver of healthy child and maternal nutrition behaviors. This study investigates the associations between exposure to Suaahara interventions and knowledge of maternal and child nutrition and health practices among mothers ( n = 1239), grandmothers ( n = 533), and male household heads ( n = 551). Linear and logistic regression models were conducted using data from the endline survey of Suaahara 's impact evaluation conducted in 2022. Exposure to Suaahara was associated with mothers' and grandmothers' knowledge of ideal child and maternal health and nutrition practices. Compared to those unexposed to Suuahara , mothers and grandmothers who were exposed to Suaahara interventions had 2.09 and 2.23 times higher odds respectively ( p = 0.001; p = < 0.001), respectively, of having correct knowledge of exclusive breastfeeding, and 1.48 and 1.47 times higher odds respectively, of having correct knowledge of age of introduction of all types of complementary foods ( p = 0.005; p = 0.070). Furthermore, exposed mothers had 1.49 times higher odds ( p = 0.021) and exposed grandmothers had 1.42 times higher odds ( p = 0.09) of knowing that young children should be fed more during illness. Male household heads who were exposed had 1.71 times higher odds of knowing that colostrum should be given to children immediately after birth ( p = 0.027). Exposure to Suaahara was also associated with mothers' and grandmothers' knowledge of ideal maternal health and nutrition practices. Exposed mothers had 1.64 times higher odds ( p = 0.011) and grandmothers had 2.92 times higher odds ( p < 0.001) of knowing that mothers should take iron and folic acid supplementation for 180 days during pregnancy ( p = 0.011; p = < 0.001). Exposed grandmothers had 1.87 times higher odds of having correct knowledge that mothers should have at least 4 antenatal care visits ( p = 0.012). Exposed mothers and grandmothers had 1.88 and 1.90 times higher odds of having correct knowledge that mothers need at least 3 postnatal care visits ( p = 0.002; p = 0.051). This study highlights multiple positive associations between exposure to Suaahara and knowledge of mothers and grandmothers around maternal and child health and nutrition practices. This effect was less pronounced in male household heads suggesting that tailored interventions are necessary to improve knowledge of appropriate child and maternal nutrition and health practices in this group. Future research should consider collecting data from multiple household members to better understand the paths between their knowledge and impact on maternal and child health and nutrition practices.

Background: Food insecurity (FI) is linked to mental health outcomes cross-sectionally, but little is known about temporal patterns of FI and changes in mental health. FI can exacerbate the mental health challenges of managing diabetes, creating a vicious cycle that worsens youth and young adults’ (YYAs) mental well-being. Purpose: We investigated the association of temporal patterns of FI with symptoms of depression, anxiety, and stress, and changes therein in YYAs with youth-onset type 1 (T1D) and type 2 diabetes (T2D). Methods: Longitudinal data (2016–2022) including three time points (t ₁ , t ₂ , and t ₃ ) from 747 YYAs with T1D and 97 YYAs with T2D were analyzed using multivariable linear regression. Ascertained with the Household Food Security Survey Module, food security was classified as persistently food secure, persistently food insecure (PFI), and intermittently food insecure (IFI). Mental health at t ₃ and changes from t ₂ to t ₃ were characterized with the Center for Epidemiologic Studies Depression Scale, the Generalized Anxiety Disorder Scale, and Cohen’s Perceived Stress Scale. Findings: Among YYAs with T1D and T2D, 6.6% and 16.5% were PFI, 20.3% and 42.3% were IFI, respectively. In YYA with T1D, PFI and IFI were associated with greater depressive, anxiety, and stress symptoms at t ₃ , and with increased symptoms over time. In YYA with T2D, PFI was associated with greater depressive symptoms at t ₃ but not with changes over time. Interpretation: The study identified a previously unrecognized link between prolonged exposure to FI and increased incidence of mental health issues. Both persistent and intermittent FI were associated with adverse mental health symptoms in YYA with diabetes, more so for those with PFI. Subsequent research should prioritize interventions that address FI in this population to evaluate their effectiveness in enhancing both physical and psychological well-being. It should be designed to not only address FI, but also comprehensive support, including mental health services and education.