Stress Management for Food Insecurity

Overseen By A. Janet Tomiyama, Ph.D.

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Los Angeles

Must not be taking: Steroids, Hormonal contraceptives

Disqualifiers: Mood disorders, Schizophrenia, PTSD, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

400 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will use a within-subjects design in a sample of individuals with a range of food insecurity recruited from the Los Angeles community (N = 400; 50% men). These participants will then, in counterbalanced order, be exposed to a gold-standard laboratory stressor and a control condition, one month apart. Moderation analyses will test whether cortisol reactivity to the stressor acts as a modulator of the relationship between high levels of food insecurity and increased hyperpalatable food intake.

Do I need to stop taking my current medications for the trial?

The trial does not specify if you need to stop taking your current medications, but it excludes those with recent diagnoses of certain disorders or those using steroids or hormonal contraceptives.

What data supports the effectiveness of the High-Stress Intervention treatment for managing food insecurity?

The study on self-efficacy and food security in a food pantry program shows that interventions focusing on self-efficacy (belief in one's ability to succeed) and motivational interviewing can improve food security. This suggests that stress management techniques, which often enhance self-efficacy, could be effective in addressing food insecurity. ^{1 2 3 4 5}

How does the stress management treatment for food insecurity differ from other treatments?

This treatment is unique because it focuses on managing stress specifically related to food insecurity, which is often linked to mental health issues like anxiety and depression. Unlike other treatments that might address food insecurity through direct food aid, this approach aims to alleviate the stress caused by the lack of food, potentially improving mental health outcomes. ^{6 7 8 9 10}

Research Team

A. Janet Tomiyama, Ph.D.

Principal Investigator

University of California, Los Angeles

Eligibility Criteria

This trial is for English-speaking adults over the age of 18 living in Los Angeles who experience varying levels of food insecurity. It's not suitable for those on strict diets, with recent metabolic or psychiatric diagnoses, pregnant women, individuals allergic to foods provided during the study, or those diagnosed with an eating disorder within the last year.

Inclusion Criteria

I am 18 years old or older.

English-speaking

Exclusion Criteria

Allergy to any of the foods in the food buffet

Participation in strict dieting or caloric restriction

I was diagnosed with a hormone-related condition or have used steroids or hormonal contraceptives in the last year.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Experimental (High-Stress) Arm

Participants are exposed to a gold-standard laboratory stressor, the Trier Social Stress Test, involving a speech task and a mental arithmetic task

1 day

1 visit (in-person)

Control Arm

Participants undergo low-stress equivalents to the speech and mental arithmetic tasks from the experimental arm

1 day

1 visit (in-person)

Follow-up

Participants are monitored for hyperpalatable food intake immediately after the intervention

1 day

Treatment Details

Interventions

• High-Stress Intervention

Trial Overview The study examines how cortisol (a stress hormone) reactivity influences the consumption of highly palatable foods among people facing food insecurity. Participants will undergo a high-stress intervention and a control condition one month apart to see if stress affects their eating behaviors.

Participant Groups

Group I: Experimental (High-Stress) Arm Experimental Treatment 1 Intervention

Participants undergoing the experimental (high-stress) arm are exposed to a gold-standard laboratory stressor, the Trier Social Stress Test (Kirschbaum et al., 1993). Participants are given five minutes to prepare for a five-minute speech task followed by a five-minute mental arithmetic task in front of two panelists wearing white lab coats (i.e., a male and female research assistant). The speech task posits the participant in a mock interview, with the two panelists listening to the speech in an unresponsive, neutral manner and asking standardized probing questions. Participants undergoing the mental arithmetic task are instructed to subtract odd numbers (i.e., 7 and 13) from a large number (i.e., 2935) as quickly as possible. If the participant makes a mistake, the panelist interrupts them and instructs them to start the task again from the beginning. The panelists also constantly remind the participant to "go faster" if they start to slow down with the task.

Group II: Control Arm Active Control 1 Intervention

Participants undergoing the control arm are presented with low-stress equivalents to the speech and mental arithmetic tasks from the experimental (high-stress) arm. For the speech task, participants are instructed to talk out loud to themselves for five minutes about a movie or book of their choice. Their speech is recorded using a small audio recorder device the research assistant prepares. For the mental arithmetic task, participants are instructed to count by increments of 15 starting from zero to the largest number they can reach. Participants are left in the room alone for the task for five minutes, after which the participant self-reports to the research assistant the number they reached.

Who Is Running the Clinical Trial?

University of California, Los Angeles

Lead Sponsor

Trials

1,594

Recruited

10,430,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Findings from Research

A study involving 6,270 households across the US found that a history of disruptive life events among parents, such as job loss or mental health hospitalization, significantly increases the likelihood of persistent household food insecurity.

Households with one or both parents experiencing these disruptive events had over six times the probability of facing ongoing food insecurity compared to those without such parental risk factors, highlighting the need for targeted interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parental History of Disruptive Life Events and Household Food Insecurity. Jackson, DB., Vaughn, MG.[2018]

In a study conducted at Student-run Free Clinics in San Diego, 92.5% of patients were screened for food insecurity, revealing that 74% were food insecure, including 30.7% with very low food security.

The implementation of a food insecurity screening and referral program successfully connected patients to resources, with 201 participants receiving monthly food boxes and others accessing food pantries and SNAP, highlighting the importance of addressing food insecurity in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of a food insecurity screening and referral program in student-run free clinics in San Diego, California. Smith, S., Malinak, D., Chang, J., et al.[2020]

The study found that for African American caregivers in low-income urban areas, each additional risk factor (like unemployment or depression) increased the odds of experiencing food insecurity by 54%.

Latent class analysis identified three distinct risk profiles, with caregivers in the high stress/depression group having 4.7 times higher odds of food insecurity compared to those with low risk, highlighting the need for targeted interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of risk for food insecurity among African American urban households: utilizing cumulative risk indices and latent class analysis to examine accumulation of risk factors. O'Reilly, NL., Hager, ER., Harrington, D., et al.[2022]

The Freshplace intervention, which incorporates client-choice and motivational interviewing, significantly improved self-efficacy and reduced very low food security among food pantry clients, as shown in a randomized control trial with 227 participants over 18 months.

Higher self-efficacy was independently linked to decreased food insecurity, highlighting the importance of empowering clients in food pantry settings to enhance their food security outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-efficacy is associated with increased food security in novel food pantry program. Martin, KS., Colantonio, AG., Picho, K., et al.[2020]

A study involving 372 parents in Philadelphia showed that those who fully participated in trauma-informed programming (attending 4 or more sessions) had 55% lower odds of experiencing household food insecurity (HFI) compared to those with low or no participation.

The trauma-informed approach not only helps reduce food insecurity but may also alleviate trauma-related symptoms linked to depression and poverty, highlighting its potential as an effective intervention for vulnerable families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trauma-Informed Financial Empowerment Programming Improves Food Security Among Families With Young Children. Phojanakong, P., Welles, S., Dugan, J., et al.[2021]

The Food Stress Index and Food Basket Recommendation tools have proven effective in helping organizations provide emergency food relief during crises like the COVID-19 pandemic and bushfires in Australia, as shown through qualitative interviews with eight key stakeholders.

The study highlights that these tools not only enhance the confidence of organizations in addressing food insecurity but also emphasize the importance of collaboration among various sectors to improve food relief efforts in times of need.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using the Food Stress Index for Emergency Food Assistance: An Australian Case Series Analysis during the COVID-19 Pandemic and Natural Disasters. Pollard, CM., Landrigan, TJ., Gray, JM., et al.[2021]

In a study of 630 rural South Carolina residents during COVID-19, those facing high food insecurity were 6.1 times more likely to report higher stress levels and 3.3 times more likely to report increased stress since the pandemic compared to those with low food insecurity.

The study found that a supportive neighborhood social environment and better food access can reduce the negative effects of food insecurity on stress, highlighting the importance of community-level factors in addressing food insecurity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Food Insecurity and Stress Among Rural Residents in South Carolina: The Moderating Influences of Household Characteristics, Neighborhood Social Environment and Food Environment. Koob, C., Luo, Y., Mobley, C., et al.[2023]

In a study of 1,683 adults in Criciúma, Brazil, food insecurity was prevalent at 25.8% in 2019 and decreased to 21.6% in 2020, indicating a slight improvement during the pandemic.

Before the pandemic, food insecurity was linked to a 29% increase in perceived stress, but this association did not hold during COVID-19, suggesting that the pandemic may have altered the relationship between food insecurity and stress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Household food insecurity before and during COVID-19 pandemic and its association with perceived stress: population-based studies. Meller, FO., Santos, LPD., Vargas, BL., et al.[2023]

In a study of 32 low-income mother-child pairs, children experiencing food insecurity had significantly higher hair cortisol concentrations (HCC), indicating increased stress levels compared to those with food security.

The food security status of both mothers and children was linked to mothers' perceived distress and coping abilities, suggesting that improving food security could enhance mental health outcomes for both mothers and children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Food Security Status and Hair Cortisol among Low-income Mother-Child Dyads. Ling, J., Robbins, LB., Xu, D.[2020]

A study of 616 respondents revealed that 73.9% identified as food insecure, with negative nutrition coping strategies increasing as food insecurity worsened; for example, those with very low food security often reported 'Eating less so children or others have enough food.'

The research identified distinct subgroups based on behaviors and demographics, such as 'late adult worriers' and 'middle adult traders,' highlighting the complexity of food insecurity and the need for tailored interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Investigation of the multidimensional determinants of negative nutrition coping strategies and tradeoffs in adults accessing food relief: A secondary data analysis. Wright, L., Marsland, C., Ross, J., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Parental History of Disruptive Life Events and Household Food Insecurity. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Implementation of a food insecurity screening and referral program in student-run free clinics in San Diego, California. [2020]

3. England pubmed.ncbi.nlm.nih.gov

Assessment of risk for food insecurity among African American urban households: utilizing cumulative risk indices and latent class analysis to examine accumulation of risk factors. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Self-efficacy is associated with increased food security in novel food pantry program. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Trauma-Informed Financial Empowerment Programming Improves Food Security Among Families With Young Children. [2021]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Using the Food Stress Index for Emergency Food Assistance: An Australian Case Series Analysis during the COVID-19 Pandemic and Natural Disasters. [2021]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Food Insecurity and Stress Among Rural Residents in South Carolina: The Moderating Influences of Household Characteristics, Neighborhood Social Environment and Food Environment. [2023]

8. Brazil pubmed.ncbi.nlm.nih.gov

Household food insecurity before and during COVID-19 pandemic and its association with perceived stress: population-based studies. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Food Security Status and Hair Cortisol among Low-income Mother-Child Dyads. [2020]

10. England pubmed.ncbi.nlm.nih.gov

Investigation of the multidimensional determinants of negative nutrition coping strategies and tradeoffs in adults accessing food relief: A secondary data analysis. [2023]