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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how stress affects eating habits, particularly in individuals facing food insecurity (limited access to nutritious food). Participants will encounter two scenarios: a high-stress situation involving a speech and math task, and a low-stress scenario such as discussing a favorite movie. Researchers seek to determine if stress alters eating patterns, especially regarding foods that are highly appealing but not very nutritious. The study is recruiting English-speaking individuals over 18 in Los Angeles who experience food insecurity but have no recent diagnoses of certain psychiatric or eating disorders. As an unphased study, this trial offers a unique opportunity to contribute to understanding stress and eating behaviors, potentially benefiting future interventions.

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 prior data suggests that this stress management protocol is safe?

Research has shown that the High-Stress Intervention, which includes a stress test with public speaking and math tasks, is generally well-tolerated by participants. The treatment aims to induce temporary stress, and no serious problems have been directly linked to this stressor. The Trier Social Stress Test, used in this study, has been widely applied in research without major safety issues.

Most participants experience only brief stress reactions, such as a faster heartbeat or sweating, which are normal responses to stress. These reactions typically subside soon after the test. Any discomfort is usually mild and quickly managed. This suggests the intervention is safe for most people, but anyone with specific concerns should consult a doctor before participating. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Stress Management for Food Insecurity trial because it explores how stress impacts those facing food insecurity in a way that's different from existing approaches. Most current treatments for food insecurity focus on providing resources or nutritional education. This trial, however, uses a unique method by inducing stress through the Trier Social Stress Test and examining its effects, potentially unveiling how stress management can be a crucial part of addressing food insecurity. This approach is innovative because it highlights the psychological aspects of food insecurity, which are often overlooked, and could lead to more holistic treatment strategies in the future.

What evidence suggests that this high-stress intervention is effective for managing food insecurity?

This trial will compare a high-stress intervention with a control arm to understand stress's impact on eating habits. Research has shown that stress can lead to increased consumption of unhealthy foods, particularly those high in fat and sugar. One study found that people with higher cortisol levels, a stress hormone, tend to snack more on these foods. The Trier Social Stress Test, used in the high-stress intervention arm of this trial, commonly measures stress and observes its effects on eating behavior. Other research suggests that stress might increase food intake by altering brain function. Understanding this connection can aid in developing strategies to manage stress and improve eating habits. ^{6 7 8 9 10}

Who Is on the Research Team?

A. Janet Tomiyama, Ph.D.

Principal Investigator

University of California, Los Angeles

Are You a Good Fit for This Trial?

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

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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 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 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]

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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8540677/

Stress Responsiveness and Emotional Eating Depend on ... Stress responsiveness seems to stimulate unhealthy and emotional eating, ie, strong cortisol reactivity was linked to higher fat/sweet snack intake.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12040751/

The Interplay of Food Insecurity, Resilience, Stress Mindset ... FI was linked to reduced resilience and increased mental distress (p < 0.05), but did not produce an effect on stress mindset.

3. researchgate.net researchgate.net/figure/Group-differences-in-stress-response-and-food-parameters-after-Trier-Social-Stress-Test_tbl2_355431567

Group differences in stress response and food parameters ... Group differences in stress response and food parameters after Trier Social Stress Test induction. Source publication. Experimental design of the study.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0306453014002157

Psychosocial stress influences chewing frequency ... Psychosocial stress is accompanied by an increase in the activity of the hypothalamic-pituitary-adrenocortical (HPA)-axis and by an increase in food intake.

5. bmcnutr.biomedcentral.com bmcnutr.biomedcentral.com/articles/10.1186/s40795-024-00922-1

Focusing attention on the important association between food ... Sleep problems, anxiety, depression, lower life satisfaction, obesity, and a higher rate of smoking were among the secondary outcomes.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7282962/

Food Insecurity and Psychological Distress: A Review of ... This review provides current information on research examining the association between food insecurity and psychological distress.

7. withpower.com withpower.com/trial/phase-1-2022-8f9a7

Stress Management for Food Insecurity 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, ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11216972/

Lifetime stressor exposure, eating expectancy, and acute ... When eating expectancies were high, acute social stress-induced negative affect predicted greater M&M intake for women with very high total lifetime stressor ...

9. sciencedirect.com sciencedirect.com/science/article/pii/S0033350623002986

Evaluation of food security status, psychological well-being ... The purpose of this study was to evaluate food insecurity on body mass index (BMI) and diet-related behaviors among college students

10. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1002/hsr2.70787

The Interplay of Food Insecurity, Resilience, Stress Mindset ... FI was linked to reduced resilience and increased mental distress (p < 0.05), but did not produce an effect on stress mindset.