Evidence of the validity of the Food and Nutritional Security Scale for adolescents (ESANa)

Vale, Marjorie Rafaela Lima do; Santos, Walberto Silva dos; Pontes Junior, José Airton de Freitas; Diniz, Renata Belizário; Ávila, Maria Marlene Marques

doi:10.1590/1413-81232020261.35892018

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FREE THEMES • Ciênc. Saúde Colet. 26 (01) • Jan 2021 • https://doi.org/10.1590/1413-81232020261.35892018 copy

Evidence of the validity of the Food and Nutritional Security Scale for adolescents (ESANa)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to develop a valid and reliable scale for assessing food and nutritional insecurity, specifically in adolescents. The initial version of the scale consisted of two subscales: perception of food insecurity and perception of nutritional security. The items were submitted to content analysis (n = 4) by a group of food and nutrition security experts, and semantic analysis (n = 20) by a group of adolescents conveniently sampled from the target population. After adjustments, the final version of the scale was applied to adolescent students (n = 425) aged 12 to 18 years (m = 14.32±0.96; CV = 6.7%). A two-factor model was the most appropriate after performing exploratory factor analysis. The subscales showed modest values of the alpha coefficient (0.69 and 0.60, respectively). Daily consumption of fruits, vegetables and soft drinks was significantly associated with higher scores in the food and nutrition security perception scale. Therefore, it is recommended to combine food access-based items with other aspects related to attitudes and behaviors towards healthy eating in order to achieve a more accurate picture of adolescent’s needs and better guide public policies.

Key words:
Validation studies; Food and Nutritional Security; Adolescent

Variables	N	%	Mean (Standard Deviation)
Gender
Female	229	53.88
Male	196	46.12
Age
12 -\| 14	283	66.59
15 -\| 17	136	32	14.32 (±0.96)
>18	3	0.71
School
Public	239	56.24
Private	186	43.76
Household head schooling
Illiterate	3	0.71
Up to 4th grade	35	8.24
Elementary School	63	14.82
Secondary School	112	26.35
Higher Education	91	21.41
Number of people < 18 years in the household
Up to 3 residents	392	92.24
4-6 residents	29	6.82	1.85 (±1.10)
>7 residents	1	0.24
ABEP classification*
A1	3	0.71
A2	26	8.47
B1	58	13.65
B2	75	17.65
C1	56	13.18
C2	32	7.53
D	4	0.94
E	0	0

Items	Clarity	Practical relevance	Theoretical relevance
Food insecurity perception scale
Q1. I eat healthy meals.	0.85	1.00	1.00
Q2. I have to work to afford money to eat.	0.90	0.80	0.95
Q3. I spend the whole day without eating.	0.80	1.00	1.00
Q4. I worry about the lack of food in my house.	1.00	0.90	0.90
Q5. I’m hungry, but I have nothing to eat.	1.00	1.00	1.00
Q6. I eat a lot in a meal as there might be no more the next day.	0.75¹1 Stang J, Story M. Adolescent Growth and Development. In: Story M, Stang J, organizadores. Guidelines for adolescent nutrition services. Minneapolis: Center for Leadership, Education and Training in Maternal and Child Nutrition, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; 2005. p. 1-8.	0.86	1.00
Q7. I have few food options daily.	0.80	0.95	1.00
Q8. I skip meals.	0.70¹1 Stang J, Story M. Adolescent Growth and Development. In: Story M, Stang J, organizadores. Guidelines for adolescent nutrition services. Minneapolis: Center for Leadership, Education and Training in Maternal and Child Nutrition, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; 2005. p. 1-8.	0.90	0.85
Q9. I eat at relatives and friends because I don’t have food at home.	1.00	0.90	0.90
Nutrition Security Perception Scale
Q10. I consider myself careful with my health.	0.85	1.00	1.00
Q11. I read health texts and information.	1.00	0.70¹1 Stang J, Story M. Adolescent Growth and Development. In: Story M, Stang J, organizadores. Guidelines for adolescent nutrition services. Minneapolis: Center for Leadership, Education and Training in Maternal and Child Nutrition, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; 2005. p. 1-8.	0.80
Q12. I read the label of the foods I eat.	0.90	0.80	0.80
Q13. I care about the quality of the food I eat.	0.90	0.90	0.95

Items	F1	F1	h2	CITC	Alpha if deleted
Q18. I care if the foods I eat are healthy.	0.82		0.679	0.664	0.60
Q13. I read the nutritional information that is on the food label.	0.64		0.412	0.616	0.63
Q16. I care about the quality of the water I drink.	0.56		0.334	0.548	0.65
Q19. I look at the expiration date of the food before eating.	0.52		0.272	0.554	0.65
Q1. I eat healthy meals.	0.52		0.269	0.422	0.65
Q14. I care if the foods I eat are contaminant/dirt-free.	0.47		0.223	0.546	0.66
Q12. I read texts or see programs with information about food.	0.42		0.179	0.541	0.66
Q3. I spend the whole day without eating.	-0.34		0.140	0.076	0.68
Q9. I skip meals.	-0.26		0.089	0.177	0.69
Q5. I’m hungry, but I have nothing to eat.		0.73	0.555	0.589	0.53
Q7. I eat a lot in a meal because there may be no more after.		0.70	0.495	0.702	0.49
Q8. I have few food options daily.		0.68	0.469	0.692	0.52
Q10. I eat at relatives and friends because I don’t have food at home.		0.63	0.434	0.428	0.58
Q4. The lack of food in my house causes me concern.		0.60	0.361	0.654	0.56
Q2. I have to work in order to eat.		0.50	0.255	0.368	0.61
Eigenvalue	2.60	2.57
Proportional variance	0.17	0.17

	n	%
Nutrition Security Perception Scale (M=22.18; sd=3.88)
Low (<20 points)	129	30.3
Medium (20 to 25 points)	215	50.6
High (>25 points)	81	19.1
Food insecurity perception scale (M=7.95; sd=2.69)
Low (<6 points)	197	46.3
Medium (6 to 9 points)	139	32.7
High (>9 points)	89	21

Sociodemographic, consumption and nutritional status variables	Nutritional security				Food insecurity
	Low	Medium	High	p-value^a	Low	Medium	High	p-value^a
School type
Public	29.3	51.5	19.2	0.66^b	41.4	35.9	22.6	0.03^b
Private	31.7	49.5	18.8	0.66^b	52.7	28.5	18.8	0.03^b
Schooling
Illiterate	35.5	49.2	15.3	0.29^a	42.7	33.9	23.4	0.36^a
Up to 4th grade	34.3	54.3	11.4		40	37.1	22.9
Elementary school	23.8	65.1	11.1		52.4	22.2	25.4
Secondary school	29.4	42	28.6		43.7	40.2	16.1
Higher education	27.5	51.7	20.8		52.7	27.5	19.8
Nutritional status
Underweight	25	75	0	0.53^a	75	25	0	0.82^a
Eutrophic	28.5	51.2	19.6		44.1	34.9	21
Overweight	32.6	50	17.4		46.5	30.2	23.3
Daily consumption of fruits
Yes	28.9	50	21.1	0.009^b	47.9	31.6	20.5	0.09^b
No	40.5	57.1	2.4	0.009^b	33.3	40.5	26.2	0.09^b
Daily consumption of vegetables
Yes	19.9	52.5	27.6	<0.001^b	50.9	27.5	21.6	0.16^b
No	43.3	48.1	8.6	<0.001^b	40.6	39.1	20.3	0.16^b
Daily consumption of soft drinks
Yes	32.1	52.6	15.3	0.001^b	47.6	32.7	19.7	0.22^b
No	23.1	41.5	35.4	0.001^b	41.5	32.9	25.6	0.22^b

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[1] Collaborations

MRL Vale: responsible for the concept and design of the study, data collection, analysis and interpretation, writing, review and final approval of the manuscript. WS Santos: responsible for the review of the design of the study, data analysis and interpretation, and review and final approval of the manuscript. JA Pontes Junior: responsible for the review of data analysis and interpretation, and review and final approval of the manuscript. RB Diniz: responsible for the review and final approval of the manuscript. MMM Ávila: responsible for the review of the design of the study and data interpretation, and review and final approval of the manuscript.