"I eat chocolate milk for dinner because we just have nothing in our fridge": The invisible burden and dire consequences of food insecurity for people with cystic fibrosis in the United States.

cystic fibrosis food insecurity nutrition qualitative research stigma

Journal

Pediatric pulmonology
ISSN: 1099-0496
Titre abrégé: Pediatr Pulmonol
Pays: United States
ID NLM: 8510590

Informations de publication

Date de publication:
23 Jul 2024
Historique:
revised: 21 06 2024
received: 06 05 2024
accepted: 10 07 2024
medline: 23 7 2024
pubmed: 23 7 2024
entrez: 23 7 2024
Statut: aheadofprint

Résumé

One-third of people with cystic fibrosis (pwCF) are food insecure, with profound negative implications for their health. This qualitative study explored lived experiences with food insecurity among pwCF or their caregivers and summarized their perspectives on food insecurity screening in the cystic fibrosis (CF) programs where they receive care. Semi-structured qualitative interviews were conducted with two groups: (1) adults with CF and (2) parents or caregivers of children with CF. PwCF or their caregivers with previously documented food insecurity were referred for participation by pediatric and adult CF programs across the United States. Interviews were recorded and transcribed, and data were coded and analyzed by two independent coders using a content-analysis approach with a constant comparative method to generate themes. A total of 26 participants from 22 CF programs were interviewed. The sample included 17 adults with CF and nine parents of children with CF. Participants were predominantly White (88%) and female (92%). Five overarching themes emerged: (1) food insecurity among CF patients and their families is onerous, (2) financial constraints imposed by the CF disease contribute to food insecurity, (3) federal and state programs provide limited food assistance, and other support is minimal, (4) shame and stigma engulf conversations around food insecurity with CF care teams, and (5) food insecurity screening in clinical settings is critical. Food insecurity among pwCF is invisible, but its consequences are dire. Assistance is limited, screening is inconsistent, and stigma is widespread. There is an urgent need to normalize food insecurity screening, standardize the screening process, and expand food assistance programs for pwCF.

Sections du résumé

BACKGROUND BACKGROUND
One-third of people with cystic fibrosis (pwCF) are food insecure, with profound negative implications for their health. This qualitative study explored lived experiences with food insecurity among pwCF or their caregivers and summarized their perspectives on food insecurity screening in the cystic fibrosis (CF) programs where they receive care.
METHODS METHODS
Semi-structured qualitative interviews were conducted with two groups: (1) adults with CF and (2) parents or caregivers of children with CF. PwCF or their caregivers with previously documented food insecurity were referred for participation by pediatric and adult CF programs across the United States. Interviews were recorded and transcribed, and data were coded and analyzed by two independent coders using a content-analysis approach with a constant comparative method to generate themes.
RESULTS RESULTS
A total of 26 participants from 22 CF programs were interviewed. The sample included 17 adults with CF and nine parents of children with CF. Participants were predominantly White (88%) and female (92%). Five overarching themes emerged: (1) food insecurity among CF patients and their families is onerous, (2) financial constraints imposed by the CF disease contribute to food insecurity, (3) federal and state programs provide limited food assistance, and other support is minimal, (4) shame and stigma engulf conversations around food insecurity with CF care teams, and (5) food insecurity screening in clinical settings is critical.
CONCLUSIONS CONCLUSIONS
Food insecurity among pwCF is invisible, but its consequences are dire. Assistance is limited, screening is inconsistent, and stigma is widespread. There is an urgent need to normalize food insecurity screening, standardize the screening process, and expand food assistance programs for pwCF.

Identifiants

pubmed: 39041893
doi: 10.1002/ppul.27179
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Cystic Fibrosis Foundation

Informations de copyright

© 2024 The Author(s). Pediatric Pulmonology published by Wiley Periodicals LLC.

Références

McDonald CM, Alvarez JA, Bailey J, et al. Academy of nutrition and dietetics: 2020 cystic fibrosis evidence analysis center evidence‐based nutrition practice guideline. J Acad Nutr Diet. 2021; 121(8):1591‐1636.e3. doi:10.1016/j.jand.2020.03.015
Saxby N., Painter C., Kench A., King S., Crowder T., van der Haak N. and the Australian and New Zealand Cystic Fibrosis Nutrition Guideline Authorship Group (2017). Nutrition Guidelines for cystic fibrosis in Australia and New Zealand. In Scott CB, ed. Thoracic Society of Australia and New Zealand.
Stallings VA, Stark LJ, Robinson KA, Feranchak AP, Quinton H. Evidence‐Based practice recommendations for nutrition‐related management of children and adults with cystic fibrosis and pancreatic insufficiency: results of a systematic review. J Am Diet Assoc. 2008;05/01/2008 108(5):832‐839. doi:10.1016/j.jada.2008.02.020
Schindler T, Michel S, Wilson AWM. Nutrition management of cystic fibrosis in the 21st century. Nutr Clin Pract. 2015;30(4):488‐500. doi:10.1177/0884533615591604
Yen EH, Quinton H, Borowitz D. Better nutritional status in early childhood is associated with improved clinical outcomes and survival in patients with cystic fibrosis. J Pediatr. 2013;162(3):530‐535.e1. e1.
Konstan MW, Butler SM, Wohl MEB, et al. Growth and nutritional indexes in early life predict pulmonary function in cystic fibrosis. J Pediatr. 2003;142(6):624‐630.
Leonard A, Bailey J, Bruce A, et al. Nutritional considerations for a new era: A CF foundation position paper. J Cyst Fibros. 2023;22(5):788‐795. doi:10.1016/j.jcf.2023.05.010
U.S. Department of Agriculture ERS. Definitions of food security. Accessed May 3 2023. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/
Seyoum S, Regenstein M, Benoit M, et al. Cost burden among the CF population in the United States: A focus on debt, food insecurity, housing and health services. J Cyst Fibros. 2023;22(3):471‐477. doi:10.1016/j.jcf.2023.01.002
Lim JT, Ly NP, Willen SM, et al. Food insecurity and mental health during the COVID‐19 pandemic in cystic fibrosis households. Pediatr Pulmonol. 2022;57(5):1238‐1244. doi:10.1002/ppul.25850
Corbera‐Hincapie MA, Kurland KS, Hincapie MR, et al. Geospatial analysis of food deserts and their impact on health outcomes in children with cystic fibrosis. Nutrients. 2021;13(11):3996. doi:10.3390/nu13113996
Brown PS, Durham D, Tivis RD, et al. Evaluation of food insecurity in adults and children with cystic fibrosis: community case study. Front Public Health. 2018;6:348.
Cockerham WC, Hamby BW, Oates GR. The social determinants of chronic disease. Am J Prev Med. 2017;52(1S1):S5‐S12. doi:10.1016/j.amepre.2016.09.010
Eicher‐Miller HA, Graves L, McGowan B, et al. A scoping review of household factors contributing to dietary quality and food security in low‐income households with school‐age children in the United States. Adv Nutr. Jul 2023;14(4):914‐945. doi:10.1016/j.advnut.2023.05.006
Vilar‐Compte M, Burrola‐Méndez S, Lozano‐Marrufo A, et al. Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review. Int J Equity Health. Jan 20 2021;20(1):40. doi:10.1186/s12939-020-01330-0
Mekonnen T, Havdal HH, Lien N, et al. Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review. Obesity Rev. 2020;21(7):e13016. doi:10.1111/obr.13016
Taylor‐Robinson D, Whitehead M, Diggle P, Smyth R. SP1‐53 the effect of social deprivation on weight in the UK cystic fibrosis population. J Epidemiol Commun Health. 2011;65:A389. doi:10.1136/jech.2011.142976n.30
Taylor‐Robinson DC, Smyth RL, Diggle PJ, Whitehead M. The effect of social deprivation on clinical outcomes and the use of treatments in the UK cystic fibrosis population: A longitudinal study. Lancet Respir Med. Apr 2013;1(2):121‐128. doi:10.1016/S2213-2600(13)70002-X
Pinto ICS, Silva CP, Britto MCA. Perfil nutricional, clínico e socioeconômico de pacientes com fibrose cística atendidos em um centro de referência no nordeste do Brasil. J Bras Pneumol. 2009;35(2):137‐143.
Schechter MS, Shelton BJ, Margolis PA, Fitzsimmons SC. The association of socioeconomic status with outcomes in cystic fibrosis patients in the United States. Am J Respir Crit Care Med. 2001;163(6):1331‐1337.
Balmer DF, Schall JI, Stallings VA. Social disadvantage predicts growth outcomes in preadolescent children with cystic fibrosis. J Cyst Fibros. 2008;7(6):543‐550. doi:10.1016/j.jcf.2008.06.004
Szentpetery S, Fernandez GS, Schechter MS, Jain R, Flume PA, Fink AK. Obesity in cystic fibrosis: prevalence, trends and associated factors data from the US cystic fibrosis foundation patient registry. J Cyst Fibros. 2022;21(5):777‐783. doi:10.1016/j.jcf.2022.03.010
Creswell JW. A concise introduction to mixed methods research. SAGE publications; 2014.
Fram SM. The constant comparative analysis method outside of grounded theory. Qual Rep. 2013;18:1.
Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004;22(2):63‐75.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32‐item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349‐357.
Niranjan SJ, Durant RW, Wenzel JA, et al. Training needs of clinical and research professionals to optimize minority recruitment and retention in cancer clinical trials. J Cancer Educ. 2019;34(1):26‐34.
Niranjan SJ, Martin MY, Fouad MN, et al. Bias and stereotyping among research and clinical professionals: perspectives on minority recruitment for oncology clinical trials. Cancer. 2020;126(9):1958‐1968.
Niranjan SJ, Wenzel JA, Martin MY, et al. Perceived institutional barriers among clinical and research professionals: minority participation in oncology clinical trials. JCO Oncol Pract. 2021;17(5):e666‐e675.
Kim Y, Mehta T, Tracy T, et al. A qualitative evaluation of a clinic versus home exercise rehabilitation program for adults with multiple sclerosis: The tele‐exercise and multiple sclerosis (TEAMS) study. Disabil Health J. 2023;16(3):101437.
Muther EF, Polineni D, Sawicki GS. Overcoming psychosocial challenges in cystic fibrosis: Promoting resilience. Pediatr Pulmonol. 2018;53(S3):86. doi:10.1002/ppul.24127
Perkins RC, Sawicki GS. High deductible insurance plans impart economic burden for people with cystic fibrosis. Pediatr Pulmonol. 2023;58(6):1798‐1801. doi:10.1002/ppul.26382
Ouyang L, Grosse SD, Amendah DD, Schechter MS. Healthcare expenditures for privately insured people with cystic fibrosis. Pediatr Pulmonol. 2009;44(10):989‐996. doi:10.1002/ppul.21090
Davies G, Rowbotham NJ, Smith S, et al. Characterising burden of treatment in cystic fibrosis to identify priority areas for clinical trials. Journal of Cystic Fibrosis. 2020;19(3):499‐502. doi:10.1016/j.jcf.2019.10.025
Thorat T, McGarry LJ, Bonafede MM, et al. Healthcare resource utilization and costs among children with cystic fibrosis in the United States. Pediatr Pulmonol. 2021;56(9):2833‐2844. doi:10.1002/ppul.25535
Cameron RA, Office D, Matthews J, et al. Treatment preference among people with cystic fibrosis. Chest. 2022;162(6):1241‐1254. doi:10.1016/j.chest.2022.07.008
Food Security and Nutrition Assistance. https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/
Berrett‐Abebe J, Reed SC. Exploring the relationship between food insecurity, chronic health conditions, and serious mental illness in the United States: Implications for social work. Health Soc Work. 2024:hlae012. doi:10.1093/hsw/hlae012
Wossenseged F, Franklin K, Gordon T, et al. Bidirectional relationship between sickle cell disease and food insecurity: Scoping review. Health Equity. 2024;8(1):238‐248. doi:10.1089/heq.2023.0147
Avery M, Wolfe J, DeCourcey DD. Economic hardship at the end of life for families of children with complex chronic conditions. J Pain Symptom Manage. Apr 2024;67(4):e313‐e319. doi:10.1016/j.jpainsymman.2023.12.014
Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low‐income NHANES participants. J Nutr. 2010;140(2):304‐310. doi:10.3945/jn.109.112573
Tian J, Ma M. Does disability necessarily lead to poverty. Int J Front Sociol. 2023;5(1):1‐7. doi:10.25236/IJFS.2023.050101
Marshall LZ, Espinosa R, Starner CI, Gleason PP. Real‐world outcomes and direct care cost before and after elexacaftor/tezacaftor/ivacaftor initiation in commercially insured members with cystic fibrosis. J Manag Care Spec Pharm. 2023;29(6):599‐606.
Gabel ME, Fox CK, Grimes RA, et al. Overweight and cystic fibrosis: An unexpected challenge. Pediatr Pulmonol. 2022;57(suppl 1):S40‐S49. doi:10.1002/ppul.25748
Szentpetery SE. Evolving nutritional needs, obesity, and overweight status in cystic fibrosis. Curr Opin Pulm Med. 2023;29(6):610‐614. doi:10.1097/MCP.0000000000001013
Oates GR, Schechter MS. Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies. Expert Rev Respir Med. 2022;16(6):637‐650.
Corbera‐Hincapie MA, Atteih SE, Stransky OM, Weiner DJ, Yann IM, Kazmerski TM. Experiences and perspectives of individuals with cystic fibrosis and their families related to food insecurity. Nutrients. 2022;14(13):2573.
Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2‐item screen to identify families at risk for food insecurity. Pediatrics. 2010;126(1):e26‐e32.
Bailey J, Baker E, Schechter MS, et al. Food insecurity screening and local food access: contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States. J Cyst Fibros. 2024;23(3):524‐531. doi:10.1016/j.jcf.2023.08.006
Oates GR, Lock L, Tarn V, et al. Electronic screening for unmet social needs in a pediatric pulmonary clinic: acceptability and associations with health outcomes. Pediatr Pulmonol. 2023;58(5):1444‐1453. doi:10.1002/ppul.26339
Ong T, Bell S, Britto MT, et al. Transforming the nutrition care model for infants with cystic fibrosis: A qualitative study of clinicians’ perspectives. Pediatr Pulmonol. 2023;58(5):1380‐1390.
Solomon GM, Bailey J, Lawlor J, et al. Patient and family experience of telehealth care delivery as part of the CF chronic care model early in the COVID‐19 pandemic. J Cyst Fibros. 2021;20:41‐46.
George C, Raymond KF, Collins L, Arefy Z, Kazmerski TM. Partnership enhancement program: piloting a communication training program for cystic fibrosis care teams. SAGE Publications Sage CA; 2021.
Sebele‐Mpofu FY. Saturation controversy in qualitative research: complexities and underlying assumptions. A literature review. Cogent Soc Sci. 2020;6(1):1838706.
Vasileiou K, Barnett J, Thorpe S, Young T. Characterising and justifying sample size sufficiency in interview‐based studies: systematic analysis of qualitative health research over a 15‐year period. BMC Med Res Methodol. 2018;18(1):148. doi:10.1186/s12874-018-0594-7
Tuckett AG. Qualitative research sampling: The very real complexities. Nurse Res. 2004;12(1):47‐61. doi:10.7748/nr2004.07.12.1.47.c5930
Sandelowski M. Real qualitative researchers do not count: the use of numbers in qualitative research. Res Nurs Health. 2001;24(3):230‐240.
Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59‐82.
Morgan M, Fischoff B, Bostrom A, Atman C. Risk Communication: A Mental Models Approach. Cambridge University Press; 2002.

Auteurs

Soumya J Niranjan (SJ)

The University of Alabama at Birmingham, Birmingham, Alabama, USA.

Georgia Brown (G)

Community Advisor to the Cystic Fibrosis Foundation, Bethesda, Maryland, USA.

Julianna Bailey (J)

The University of Alabama at Birmingham, Birmingham, Alabama, USA.

Robin Geurs (R)

The University of Alabama at Birmingham, Birmingham, Alabama, USA.

Keith J Robinson (KJ)

University of Vermont Children's Hospital, Burlington, Vermont, USA.

Michael S Schechter (MS)

Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, Virginia, USA.

Kate E Powers (KE)

Albany Medical College, Albany, New York, USA.

Cristen Clemm (C)

Cystic Fibrosis Foundation, Bethesda, Maryland, USA.

Kim Reno (K)

Cystic Fibrosis Foundation, Bethesda, Maryland, USA.

Gabriela R Oates (GR)

The University of Alabama at Birmingham, Birmingham, Alabama, USA.

Classifications MeSH