Hunger in Canadian Adolescents: A Mixed Methods Study
Determinants of Health , Hunger
Background: Children going to school or bed hungry due to lack of food at home is a public health concern in Canada. Hunger adversely affects child health and development. Social support can alleviate hunger among adults. However, limited literature exists on this in adolescents. There is a need to understand the concept of hunger and aspects of food insecurity from adolescents’ perspective in order to improve existing health promotion or nutrition programs. Objectives: This mixed methods study aims to:  assess qualitative content validity of the hunger item on the Health Behaviour in School-aged Children (HBSC) survey;  understand Canadian adolescents’ perspectives on the HBSC item and on hunger more broadly;  investigate the epidemiologic relationship between social support from parents and teachers and adolescent’s report of hunger. Methods: Manuscript 1: A qualitative exploratory study was conducted using adolescent focus groups across Ontario. Coding proceeded in three stages with codes, themes and overarching concepts identified. The relative importance of themes were determined through assessment of depth, immediacy and richness of interaction surrounding them, as well as their reoccurrence. Manuscript 2: Canadian 2009/2010 HBSC data were used to examine the relationship between social support and hunger using adjusted Poisson regression. Results:  Content validity assessment showed adolescents considered quantity, consistent access and food preference, but not food quality when answering the HBSC hunger item;  Adolescents’ discussions highlighted four overarching concepts: hunger related to family affluence, societal influences on food choice and practices, parental influence on food availability and practice, and the effect of hunger on health;  Parental and teachers’ support were independently and consistently associated with hunger. Adolescents who reported lower perceived support were also more likely to report going to school or bed hungry because there was not enough food at home. Conclusion: The HBSC hunger item should be cautiously interpreted with regards to food quality. When responding to the hunger item adolescents considered economic, social, family-related and health-related ideas. Overall, results from these studies may be informative to school- and community-based nutrition and health promotion programs that focus on the potential benefits of using social networks.