Camille Winn

November 13th 2024

Finding which food allergy and intolerance testing methods are more beneficial for finding

food insecurity in locations with high prevalence of food related health risks.

INTRODUCTION

Food insecurity is reported to impact approximately 21% of children in the USA. (Shroba

et al. 2022) All children who do not have the opportunity to be notified of such an event or

helped out of the risks that follow growing up in food insecure locations end up with chronic

diseases and have a higher risk of developing mental health issues. To have more knowledge and

information on food insecurity we need to increase the amount of screening done for food

allergies and intolerances as those tests help health professionals examine the probability of

food-related health issues.

In the search for a society and community with safe food practices and non-

discriminating practices, we need to identify the many ways that as a society we work towards a

day where all food is secure and accessible for all. While identifying the urge to better screening

practices of food insecurity and advocating for better policies to include the need for improving

food delivery concerning social determinants of health, we also should identify the past

maladaptive practices of food distribution, and even then, there is still more to be accomplished.

With all of these objectives to combat food insecurity, there is also a need to identify what

processes will enhance the decline of currently occurring food insecurity and obtain methods to

keep that decline going. Food allergies and intolerances fall near food insecurity as they correlate
with one another by impacting one another; if a person has a food intolerance it will be harder to

gain access to safe food (depending on the intolerance) and in return, if there are food insecurity

reported it might be a reason why some individuals have intolerances, due to unsafe food. Food

allergy and intolerance screening are practices done not commonly enough and the process of

different food screenings and tests are at times unknown in certain health facilities, perhaps

deepening that knowledge could get us to identify more efficiently food insecurity and the

problems that it causes or impacts.

The research question will focus on the testing of food allergies and intolerances in

accordance with food insecurity. Will the increase in testing and screening of food allergies and

intolerances aid in better identification of food insecurity? How efficient will this process be, and

could it work in reserve, would food insecurity screenings aid in findings of food intolerances

and allergies before health risks develop into chronic ones? We also will try and manage to find

which testing/screening method will be the most efficient and beneficial for individuals.

I will be researching food insecurity and its many domains involving food allergies and

intolerances that increase the health disparity potential in certain areas with other food-related

problems such as food outlets and food deserts. Surveys will be given out to recuperate

participants for more findings on the prevalence and incidence of food insecurity, food allergies,

and intolerances as well as what their interactions with food shopping and food intake are. Some

demographics will also be asked such as age, ethnicity, race, gender, socioeconomic status,

employment, and education. After surveys, which will act as criteria, additional steps such as

interviews will be taken to expand on screening information and specific food experiences. The

data recovered will help display whether food allergies and intolerances screening helps aid in

the identification of food insecure areas. It may also lead to possibly predicting if such
screenings can predict if one might be affected by food insecurity or has some kind of food

allergy or intolerance, they aren’t aware of.

LITERATURE REVIEW

This research project will focus on the impacts of food insecurity and how we can improve

our preparedness for such a diagnosis. Many factors influence and cause food insecurity, such as

health risks due to a poor nutrient-dense diet, food literacy, and substance abuse risk making it

more challenging to find out how and why this is still occurring (Larson, Laska, Neumark-

Sztainer 2020). Since we are also previously aware that poverty, race, employment status,

education, and food injustice are related to the increase in food insecurity (Laska et al. 2021), we

need to find methods that attempt to promote the best strategies for food equity by

acknowledging the inequalities that facilitate food insecurity. My proposed research will

examine if food insecurity and food allergy screening tests might help identify more food

insecurity and address the issue, which could allow for more community aid in managing food

insecurity. Firstly, we need to be aware of what food security, food allergies, and food justice

are. “Food security is defined as having consistent, dependable access to enough food for active,

healthy living” (Larson, Laska, Neumark-Sztainer 2020, p.1422). Food allergies and food

intolerances are health conditions that take shape depending on the food that an individual has

and the reaction that comes. Allergies manifest themselves quickly and usually have symptoms

such as swelling while intolerances are usually long-term symptoms that can irritate the

gastrointestinal tract (Namazova-Baranova et al. 2024). Most literature will include categories

holding information that relates to a well-adjusted explanation of the differences in food

intolerance and allergies as well as screening techniques and awareness techniques.

Research also shows the social structures that impact a person in a food insecure situation

(Minaker, Elliott, Clarke 2015) such as education on food or food literacy, co-occurring diseases,

and stigma. Several studies examine the effect of socio-economic background in different areas

and populations on the prevalence of food insecurity (Jiang et al. 2023), especially the large

disproportion of diagnosis for food insecurity in Black, Hispanic, and Native American

communities. Such instances can be explained by the “historical context of neighborhood-based

mortgage discrimination […] that perpetuate social injuries across generations” (Kyung Lee et

al. 2022, p. 2). Certain behaviors towards food can put individuals at a higher risk for other

health conditions such as food outlets (Hallum et al. 2020) or transportation to grocery stores

(Morales, Morales, Beltran 2021). Many factors can influence the risk of food insecurity such as

substance abuse, mental health, stress, sleep, support system or relationships, and academics

(Laska et al. 2021). There is research that shows that in most cases a person experiencing food

insecurity will not have access to resources or won’t be able to use the resources they might have

due to the social factors that are at play when food insecurity is experienced. This is partially due

to the co-occurring or confounding factors that make it more complex to solve food-related

issues (Shroba et al. 2022).

2. Current steps in diagnosing food insecurity, testing methods

Most common screening techniques for food insecurity are listed as being a straightforward

survey that takes place in 3 different steps and can be self-administered, it is a long process but
proves to be efficient and not very costly (Shroba et al. 2022). When it comes to food allergies

and intolerance testing there are a few options but depending on cost, insurance, and level of

testing/screening these steps are more complicated to overcome (Lavine 2012). Information

about principles that define food injustice and the possible difficulties that can be encountered

are not very common in research, the issues of food injustice and insecurity are shown to be

multifactorial and include multiple facets of health which in turn are harder to solve (Murray et

al. 2023). Some research identifies the ways of screening and addresses the impact that COVID-

19 had on not only screening methods but, also the worsening of food insecurity and its

probability for the future. Screenings decrease and the stress of food insecurity is overlooked as

the focus on pandemic food-related issues was not prioritized (Fernanda de Oliveira et al. 2023).

Researchers also identified issues with certain screening methods which will help aid in how we

can improve screening for food insecurity and food allergies (Shroba et al. 2021).

3. Stigma in food insecurity

Importantly, we must also understand the stigma that follows individuals when they have a

food allergy/intolerance or are experiencing food insecurity. Some studies focused on individuals

that have co-occurring stigma, the fact that they are experiencing both food insecurity and

poverty has shown that the intersection of multiple factors proves to be a challenge when

managing their day-to-day life and must account for their special food needs (Minaker, Elliott,

Clarke 2015). Others focus more on the stigma that is present with children in school, with the

lack of information the children or the educators have, keeping safe food management for food

allergic or intolerant children is a challenge that education on the matter can fix (Dean et al.

2015). Both addressed that stigma is a major issue in combating the elimination of food
insecurity and how the spread of misinformation or stereotypes proves to be a regular confusion.

However, it can be defeated. Stigma is our construction of social factors that we deem acceptable

or not, explaining the implication of safe food practices for all will help us get there faster.

DATA AND METHODS

My study aims to determine whether screening tests for food allergies and intolerance aid

in identifying food insecurity before health issues prevail. To get these findings in Charleston,

South Carolina, we must direct our attention to the Allergy and Asthma services at MUSC to

begin our search for participants. After acquiring a minimum of 12 total participants who must

be 18 years of age or older, interviews consisting of a few differently structured questions, will

be conducted to gather information on personal screening and food insecurity experience.

Interviews are the most appropriate method for data collection because they will be conducted in

person with open-ended questions, allowing individuals to talk about their personal experiences

rather than answering closed-ended questions via email or a letter in the mail.

The topic of this research includes food insecurity, food allergies, and food intolerance. Will the

increase in testing and screening of food allergies and intolerances aid in better identification of

food insecurity? How efficient will this process be, and could it work in reserve, would food

insecurity screenings aid in findings of food intolerances and allergies before health risks

develop into chronic ones? The focus is to find whether screenings and tests concerning food

allergies and intolerances help find food insecure locations and aid before one’s health might be

impacted. If we were able to make the best predictions about one’s health, especially their

nutritional health, we would find that screenings do help. However, what our research aims to

discover is to find out if they would work for the diagnosis of a possible food insecure situation
and if so, we can implement action for diminishing the health risks that are at hand. In the US it

has been recorded that about 11% of households dealt with the impacts of COVID-19 and

experienced food insecurity (Larson, Laska, Neumark-Sztainer 2020).

The first step in data collection is to make our way over to the Allergy and Asthma unit

where we will be recruiting participants. The idea is to arrive at the center and speak to the

doctors about the study. Once we have their consent, we will go ahead and ask participants if

they will complete a brief screener survey about food allergies and intolerance. All participants

will be required to sign an informed consent form informing them that their information will not

be shared with anyone outside the research team and they can drop out at any time. In this

survey, there will be questions about age, ethnicity, race, gender, socioeconomic, education, and

employment status followed by 7 close-ended questions that will be answered by “Yes” or “No”

and one final question that will be open-ended (Appendix A). We will then review the surveys.

If respondents answered “Yes” to questions 1 and 2, we will contact them to participate in the

interview part of this study as we needed to recruit people with food-related experiences to

allergies and intolerances rather than asthma-related issues or skin-related. Respondents who

answer “Yes” to questions 6 and/or 7 will also be contacted for a follow-up interview about their

experiences with food allergies and intolerance and their experience with screenings (Appendix

B). Follow-up consent forms will be distributed for the interview portion to review the process at

hand. Participants will also be notified that they can opt out of any question or the interview

process at any time. The sample criteria for the interviews was for participants to have answered

yes to both questions 1 and 2 of the survey and were free to accept the interview process or

decline. *
 Once questions are answered we will be able to analyze the amount of people that have a

food allergy or intolerance and of those people if they have experienced a screening or test for

their situation. All individuals that noted as being food insecure with or without having a test

performed will be recorded. Based on the number of individuals with screenings we will see if

they have experiences of food insecurity. Interview questions will be analyzed to understand the

personal experiences of all individuals and see if any personal experiences might not have been

accounted for in this research design.

LIMITATIONS AND OTHER CONSIDERATIONS

Concerns that should be addressed for this design is informed consent. There are going to

be some people who will oppose sharing their medical experiences and therefore informed

consent forms need to be brought out and signed when the surveys are being administered.

Another limitation of this study would be the sample size. There might not be a lot of people

going to the allergy and asthma unit in a specific amount of time. Another possible limitation is

the insurance status of participants, if they can come to an Allergy unit are they more likely to

have insurance, if we look at the North Charleston center, we might only be exposed to a certain

specific group of people that might be insured.

Screener Questions Guide

1. Have you or anyone in your family experienced a food allergy or intolerance?

2. Have you or anyone in your family been hospitalized due to a food allergy or intolerance

reaction?

3. Have you gotten food from the grocery store for your meals in the past 2-3 weeks?

4. When grocery shopping, do you find options for food allergies and intolerances?

5. Have you purchased something you or your family was allergic or intolerant to and only

found out later?

6. Have you had an allergy test or intolerance test?

7. Have you been screened for food insecurity?

8. If you have had a challenging/difficult experience with food tests or screenings what

were the occurrences of that experience? What methods were used and what was the

setting?

APPENDIX B

Interview Questions Guide

1. What is your overall relationship with food? Do you want to expand?

allergy/intolerance?

3. Can you recall if you have been screened for food allergies or intolerances? If so, what

test was performed? Have you been screened for food insecurity?

4. What are things you believe need to change for the better management of health risks

when it comes to food allergies and intolerances?

After my feedback on my peer review came back I definitely had a better vision of my

proposal coming together. At first the order of it felt confusion but Claire helped me group my

topics in my literature review to make a better flowing and sounding one for the reader. I felt as

though there was some detail I was leaving out so the areas where Claire was pointing to for

additional information or an extra example I added some, in the end it did sound and look much

better when reading it. Something else I did was add my research questions in the intro, it felt

that I was simply blabbing on about food insecurity until finally there are the questions that will

be answered. Something else I did thanks to my peer review is add appendix which allowed for a

better flow and a very organized paper that I find looks quite nice.
 REFERENCES:

Blue Bird Jernigan, Valarie, Alicia L. Salvatore, Dennis M. Styne, Marilyn Winkleby. 2021.

“Addressing food insecurity in a Native American reservation using community-based

participatory research” Health Education Research. 27(4):645-655

Dean Jennifer, Nancy E. Fenton, Sara Shannon, Susan J. Elliott, Ann Clarke. 2016. “Disclosing food

allergy status in schools: health-related stigma among school children in Ontario” Health and

Social Care In the Community. 24(5):43-52

Guillemin, Pierre. 2022. “Food (in)justice and social inequalities in vegetable and market garden

production in Normandy, France” Review of Agricultural, Food and Environmental Studies.

103:321-345

Hallum H. Shirelle, S. Morgan Hughey, Marilyn E. Wende, Ellen W. Stowe, and Andrew T.

Kaczynski. 2020. “Healthy and Unhealthy Food Environment are Linked with Neighborhood

Socio-economic Disadvantage: An Innovative Geospatial Approach to Understanding Food

Access Inequities” Public Health Nutrition. 23(17): 3190-3196

Headrick Gabby, Kiera Abdul, Shireen Guru, Allison DeHonney, Alyssa J. Moran, Pamela J.

Surkan, Samina Raja, and Yeeli Mui. 2024. “‘We Want to Eat and be Healthy just like

Everybody Else:’ How Social Infrastructures Affect Nutrition Equity in a Racialized Urban

Community in the United States” Current Developments in Nutrition. 8(2024) 102106

“Racial, Ethnic, and Socioeconomic Differences in Food Allergies in the US” JAMA Network

Open. 6(6)18162

Kyung Lee Eun, Gwendolyn Donley, Timothy H. Ciesielski, India Gill, Owusua Yamoah, Abigail

Roche, Roberto Martinez, and Darcy A. Freedman. 2021. “Health Outcomes in Redlined

Versus Non-Redlined Neighborhoods: A Systematic Review and Meta-analysis” Social

Science and Medicine. 294(2022) 114696.

Laska, Melissa N., Kathleen Lenk, Katherine Lust, Cydney M. McGuire, Carolyn M. Porta, Michael

Stebleton. 2021. “Sociodemographic and health disparities among students screening positive

for food insecurity: Findings from a large college health surveillance system” Preventative

Medicine Reports. 21:101297

Larson, Nicole, Melissa N. Laska, Dianne Neumark-Sztainer.2020. “Food Insecurity, Diet Quality,

Home Food Availability, and Health Risk Behaviors Among Emerging Adults: Findings

From the EAT 2010–2018 Study” Am J Public Health. 110(9):1422-1428

Lavine Elana. 2012. “Blood testing for sensitivity, allergy or intolerance to food”. Canadian Medical

Association Journal. 184(6): 666-668

Meller, Fernanda de Oliveira, Leonardo Pozza dos Santos, Bianca Languer Vargas, Micaela Rabelo

Quadra, Carla Damasio Martins, Antônio Augusto Schäfer. 2023. “Household food

insecurity before and during COVID-19 pandemic and its association with perceived stress:

population-based studies” Reports in Public Health. 39(1)

stigmas of food allergy and poverty” Critical Public Health. 25(5): 599-614

Morales, Danielle X., Stephanie A. Morales, Tyler F. Beltran. 2021. “Racial/Ethnic Disparities in

Household Food Insecurity During the COVID-19 Pandemic: a Nationally Representative

Study” Journal of Racial and Ethnic Health Disparities. 8:1300-1314

Murray Sandra, Fred Gale, David Adams, and Lisa Dalton. 2023. “A Scoping Review of the

Conceptualization of Food Justice” Public Health Nutrition. 26(4): 725-737

Namazova-Baranova, Leyla, Kamilla Efendieva, Julia Levina, Vera Kalugina. 2024. “Food Allergy

and Food Intolerance – New Developments” Global Pediatrics. 9:100201

Odoms-Young, Angela M. 2019. “Examining the Impact of Structural Racism on Food Insecurity:

Implications for Addressing Racial/Ethnic Disparities” Fam Community Health. 41: 3-6

Shaker, Yasamin, Sara E. Grineski, Timothy W. Collins, Aaron B. Flores. 2023. “Redlining, racism

and food access in US urban cores.” Agriculture and Human Values. 40:101-112

Shroba Jodi, Rajeshree Das, Lucy Bilaver, Eileen Vincent, Emily Brown, Brooke Polk, Ashley

Ramos, Anne F. Russell, J. Andrew Bird, Christina E. Ciaccio, Bruce J. Lanser, Kim Mudd,

Amika Sood, Brian P. Vickery, and Ruchi Gupta. 2021. “Food Insecurity in the Food

Allergic Population: A Work Group Report of the AAAAI Adverse Reactions to Foods

Committee” American Academy of Allergy Asthma and Immunology. 10(1):81-90