Print version ISSN 1415-790X
Rev. bras. epidemiol. vol.14 n.3 São Paulo Sep. 2011
ORIGINAL ARTICLES ARTIGOS ORIGINAIS
Bens de consumo e insegurança alimentar: diferenças de gênero, cor de pele autorreferida e condição socioeconômica
Leticia Marin-Leon; Priscila Maria Stolses Bergamo Francisco; Ana Maria Segall-Corrêa; Giseli Panigassi
Departamento de Medicina Preventiva e Social da Faculdade de Ciências Médicas da Universidade Estadual de Campinas - Campinas (SP), Brasil
Data from the National Household Survey 2004 was analyzed to compare differences
in prevalence among moderate or severe food insecurity. Also, it was compared
food security or mild food insecurity households in relation to the assets and
other socioeconomic and demographic conditions of the household.
METHOD: Private permanent households, with per capita monthly income of up to one minimum wage and with the Brazilian Food Insecurity Scale answered by a household resident were studied (n=51,357). Association of variables with the dependent variable (food security) was verified using χ2 test, with 5% significance level. Crude prevalence ratio, respective 95% confidence interval and adjusted analyses were carried out using Poisson multiple regression Stata 8.0. It considers the weights of the complex sampling design of the survey.
RESULTS: The per capita monthly household income was the variable with strongest association to food security. Both in urban and rural areas, there were higher risk of moderate or severe food insecurity prevalence ratio when the head of the household was a female, black color, presence of six or more members in the household, metropolitan area and with absence of some specific assets (stove, water filter, refrigerator, freezer, washing machine and cellular phone). In a model that, among assets, included just the refrigerator, it was observed the highest prevalence ratio for household income of up to ¼ of a minimum wage and after this, the absence of refrigerator among households headed by white and black males and white or black female. Although female and black headed households have greater food restriction, internal differences among these groups were higher for households headed by white males and lower for those headed by black females.
CONCLUSION: At national level and households with monthly income of up to one minimum age, poor socioeconomic conditions are associated to household food insecurity. This situation is worse among those headed by women and black people. Among poor people, the absence of assets identifies the most vulnerable population to food insecurity and may be used as complementary indicator, mainly in local studies with poor technical resources for data collection and more sophisticated analyzes.
Keywords: social conditions; food security; social inequality; poverty; family characteristics; socioeconomic factors.
Com base nos dados da Pesquisa Nacional por Amostra de Domicílios (PNAD,
2004), foram comparadas as diferenças na prevalência de insegurança
moderada/grave em relação à segurança alimentar,
e insegurança leve quanto à posse de bens de consumo e outras
condições socioeconômicas e demográficas.
MÉTODOS: Foram estudados os domicílios particulares permanentes, com rendimento domiciliar per capita de até um salário mínimo, utilizando-se a Escala Brasileira de Insegurança Alimentar respondida por morador do domicílio (n=51.357). A associação entre as variáveis e a variável dependente (segurança alimentar) foi verificada pelo teste do χ2 com nível de significância de 5%. Foram calculadas razões de prevalência brutas e intervalos de confiança de 95% e a análise ajustada foi conduzida por meio de regressão múltipla de Poisson, utilizando Stata 8.0, que incorpora as ponderações do desenho amostral com delineamento complexo.
RESULTADOS: A renda domiciliar mensal per capita foi a variável com maior força de associação com a segurança alimentar. Tanto em áreas urbanas quanto rurais, foram encontradas elevadas razões de prevalência para insegurança alimentar moderada ou grave nos domicílios chefiados por mulheres, de cor negra, presença no domicílio de seis ou mais moradores, localização metropolitana e com ausência de alguns bens específicos (fogão, filtro, geladeira, freezer, máquina de lavar roupa e telefone celular). Em modelo que incluiu, entre os bens, apenas a posse de geladeira, a maior razão de prevalência ocorreu na renda de até ¼ de salário mínimo, seguindo-se a ausência de posse de geladeira, tanto nos domicílios chefiados por homens brancos, como por negros e mulheres brancas ou negras. Embora os domicílios chefiados por mulheres e por negros apresentem maior insegurança alimentar, as diferenças intragrupais foram maiores em domicílios chefiados por homens brancos e menores nos de mulheres negras.
CONCLUSÃO: Em nível nacional e em domicílios com renda de até um salário mínimo, condições socioeconômicas mais precárias estão associadas à insegurança alimentar, sendo a situação agravada naqueles chefiados por mulheres e onde residem pessoas de cor autorreferida como negra. A ausência de bens identifica, entre os pobres, a população mais vulnerável à insegurança alimentar e pode se constituir em indicador complementar, sobretudo em estudos locais, onde há escassez de recursos técnicos para coleta de dados e análises mais sofisticadas.
Palavras-chave: condições sociais; segurança alimentar e nutricional; desigualdade social; pobreza; características da família; fatores socioeconômicos.
The Brazilian Food Insecurity Scale (EBIA), used in the National Household Sample Survey (PNAD) 20041 is a direct measure of the interviewee´s food insufficiency and his family in the three months preceding the survey at several levels of relative intensity2.
EBIA is an adaptation and validation for Brazil of the Household Food Security Scale Measurement3 that was built in the United States from qualitative and quantitative surveys of the 1980s4-6. It is an instrument that by enquiring for daily life access to food leads the respondents to the symbolic, cultural and social aspects of feeding, but does not replace the indirect instruments to measure food insecurity vulnerability, such as income and other social conditions linked to poverty.
The inclusion of this scale in the PNAD-2004 answers the need for information on the dimension of food insecurity and its population distribution. Using EBIA, the various spheres of government can identify the most vulnerable population and propose actions to assure permanent access to enough quantity and adequate quality of food, which has been recognized as a fundamental human right by the Brazilian legislation7.
In Brazil, using simple descriptive analysis of PNAD 2004 data, it was observed a higher prevalence of moderate or severe food insecurity (MSFI) in households: with low per capita monthly income, those located in rural areas, with at least, one resident under 18 years, female-headed, with low schooling and self-referred black (black or brown)1.
Usually, family income and schooling of heads of household are the most used indicators to define socioeconomic conditions. However, income is a questionable reliability variable because informants may refuse to report it or ignore the income of other household members. Some publications have used an index that includes the possession of some home appliances and the schooling of heads of household, as an indicator of socioeconomic status8,9, enabling the classification of the population into categories of economic classes. In 1997, ABA (Brazilian Association of Advertisers), ABIPEME (Brazilian Association of Market Research Institutes) and ANEP (National Association of Research Companies) published "Criterion Brazil", which in 2008 edition, published by ABEP (Brazilian Association of Research Companies), has five classes ranging from A (the wealthiest) to E (the poorest), and classes A, B and C have two subclasses10. The questions on household goods in PNAD-2004 are insufficient for the construction of the economic index of ABIPEME because, although some specific home appliances are listed, it does not quantify each of them and does not report the existence of a housemaid.
By studying families with familiar per capita monthly income of up to ½ minimum wage (MW), living in metropolitan areas, Torres et al11 pointed out that between 1995 and 2004 access to household goods increased primarily for telephone, washing machine and refrigerator. For these authors, the increase in consumption could be explained by the relative reduction in prices of food and home appliances and increase in consumer credit. The "marketing" of the household appliance industry and retailers that have used strategies aimed at stimulating consumption in low income population12, would be an explaining factor for increase of home goods in this social group.
One advantage of individually analyzed home appliances information would be its use as an indicator of the economic condition of poor population, particularly in cities with limited resources for more complex analysis, as the assembly of an index. It is therefore justified to study the role that household goods have on food security, assuming that home appliances could be related to both food security and food insecurity among poor population.
The aim of this study was to compare, based on PNAD 2004 data, the differences in MSFI prevalence by ownership of home appliances and other demographic and socioeconomic conditions in households with an income of up to one minimum wage per capita by month.
In PNAD-2004 interviews were conducted in 112,716 households, from which were selected 51,357 permanent private households with a per capita monthly income up to 1 MW, and those where the Brazilian Food Insecurity Scale (EBIA) was answered by a household resident.
The dependent variable was food security, although it is defined in four categories by EBIA2, for this analysis it was dichotomized joining the categories with the greatest similarity among themselves, which are food security and mild insecurity (FS/mFI) against moderate and severe insecurity (MSFI). The criterion used to link the categories was the construct similarity between food security, which is the condition of absence of any restriction, and mild insecurity, that can only represent the concern that food may come to lack or decrease the quality of diet, in other words, monotonous diet due to lack of money for greater variety of foods. Moderate insecurity is characterized not only by monotony of the diet but also by reduced amount of food at each meal, while severe insecurity also includes reduction in the number of meals representing the experience of hunger. The similarity of the categories that composed the dependent variable is even supported by the psychometric characteristics of the scale, where low severity items have high frequency of positive answers and as the question severity increases towards hunger direction, it reduces the frequency of positive answers13.
The independent variables analyzed were: per capita monthly household income dichotomized in to up to ¼ of MW and more than ¼ up to 1 MW; place of residence (urban vs rural); metropolitan location (yes vs no); characteristics of heads of household (gender, schooling up to 4 years and 5 years or more, self-referred color (white vs black/brown), age (up to 44 years and 45 or more); family characteristics - size (up to 5 vs 6 and more residents) and composition (with children and adolescent under 18 years or without residents under 18 years); elderly residents (60 and more - yes vs no) and home appliances possession (stove of two or more burners, water filter, color television, refrigerator, freezer, washing machine, cell phone, landline phone and microcomputer).
Crude prevalence and 95% confidence intervals of lack of specific home appliances were calculated, stratified by income, chi-square test was also used for statistical significance.
Also MSFI crude prevalence and their 95% confidence intervals were estimated, stratified by gender and color of heads of household and possession of a refrigerator, controlled by household income, place of residence, family size and schooling level of heads of household.
The association between independent variables and the dependent variable was tested by chi-square test with significance level of 5%. Crude prevalence ratios and 95% confidence intervals were calculated and adjusted analysis was conducted using Poisson multiple regression14.
In the multivariate model, the inclusion criterion was the association with moderate or severe food insecurity (MSFI) at p=0.20 in bivariate analysis, controlled for income range (up to ¼ of MW and more than ¼ up to 1 MW). As besides the per capita monthly household income it also has been described the associations of severe insecurity1,15 with some socioeconomic characteristics of the family and heads of households, these independent variables were included in the model as confounding variables. Backward selection procedure was used to exclude not significant variables and in the final model only remained those with p<0.01.
We decided to build yet another final model excluding the household goods except the refrigerator, considering the comments of a Rio Grande do Sul study12 which described that for the urban poor population the basic appliances are the stove and refrigerator, its absence was perceived as inconceivable. Although the refrigerator represents a monthly expense for the energy it consumes, allows, however, the purchase of perishable foods and their fractionated availability. Stove has an almost universal presence and the refrigerator is present with an intermediate frequency in the population studied. Finally, we present separate models for the four categories of households by color and gender of the heads. It is noteworthy that the number of non-response to the specific questions used in this study, the highest value was found for schooling (0.6%), other variables do not exceed 0.4%. These records were excluded from multivariate procedures.
Data analysis were performed using STATA 8.0 for analysis procedures whose population survey commands incorporate the weights required to correct the unequal selection probabilities derived from the complex sampling design.
Being an examination of a public database, managed and executed by IBGE, and the data available without identifying the respondents, the research plan of this study was not submitted to the Ethics Committee in Research, FCM-UNICAMP. The authors declare no conflicts of interest.
Most households were headed by men (74.3%) which mainly had 5 or more years of schooling. This category of schooling accounted for 41.2% in male headed households and 42.4% in female headed households. For each gender and range of schooling, households with no income and with up to ¼-MW showed the highest MSFI prevalence (data not mentioned in tables).
Table 1 shows the percentage of absence of specific home appliances according to per capita monthly household income and food security conditions. MSFI households had a greater proportion than FS/mFI households of absence of each specific home assets and still higher rates of lack of ownership of these assets were observed in households where the per capita monthly income was up to ¼ MW in comparison with households with income >1/4-1 (p<0.001). In households with up to 1 MW, the lack of stove was rare, refrigerator was intermediate, washing machine and phones high, and the presence of a computer was exceptional. Table 2 presents three explanatory models of MSFI. Although per capita monthly income is the variable that presents the highest prevalence ratio, all variables of specified home appliance remained in the model for Brazil as a whole. In the model for rural households some variables were not significantly different: "lack of resident younger than 18 years", "lack of elderly", lack of television, telephone and computer (p>0.01). Both in urban and rural areas, the highest prevalence ratio of MSFI were: in female headed households, black headed, with six or more residents and metropolitan location.
Table 3 shows that households without a refrigerator had a higher prevalence of the MSFI than those with refrigerator, especially those headed by black women (p=57.9%; 95%CI 55.4-60.3). When stratified by several variables it was observed among households headed by men and those female-headed and with no refrigerator, that the households with the highest MSFI prevalence were those with per capita monthly income up to ¼ MW (59.2% for white male-headed and 76.2 for black female-headed) and those with 6 or more residents (54.2% and 70.0% for white male and black female-headed respectively). Besides these variables, households headed by women and located in metropolitan areas also had high MSFI prevalence (56.6% among white-headed and 68.5% among black-headed). In this table the statistical significance between types of households with different characteristics of gender and color of heads of household and possession of a refrigerator was verified by lack of overlap of the 95% confidence interval of the MSFI prevalence. Among households in metropolitan areas and with six or more residents no significantly different MSFI prevalence were observed between black and white-headed households without a refrigerator.
The multiple logistic model for MSFI presented in Table 4 differs from model in Table 2 in that the only home appliance included was the refrigerator. The categories with no significative values (p>0.01) were excluded from this table. For Brazil as a whole and considering gender and color of the heads, the highest prevalence ratio were observed in per capita monthly income of up to ¼ MW (PR=1.90; 95%CI 1.85-1.96) and lack of refrigerator (PR=1.42; 95%CI 1.38-1.46). Comparing to the other gender and color groups, white male-headed households had the highest PR for MSFI. Among white and black female-headed households, the number of residents equal or higher than 6 was not a determinant of MSFI. Living in the North and Northeast regions and in metropolitan areas, were also not determining factors of MSFI among white female-headed households.
The main limitation of this study is the cross-sectional design of the PNAD restricting the inference of causality.
Whereas the prevalence of MSFI for Brazil was 18.8%1, it was found that among households with up to 1 MW, and whose heads had 4 years of schooling or less the MSFI prevalence was higher than the national average. Households without any specific home appliances showed higher MSFI prevalence than the national average, regardless of gender and schooling level of heads of household.
In the model developed for the general population of Brazil, the per capita monthly household income was the variable with strongest association with food security, both in urban and rural areas, experiencing high prevalence ratio for moderate or severe food insecurity in households headed by women, black, with six or more residents, metropolitan location and with lack of specific home appliances (stove, water filter, refrigerator, freezer, washing machine and cell phone). The income importance was pointed in a study that also used PNAD 2004 data, noting that every R$10.00 (ten reais) added to the family income, from some social income transfer program, the household chances of food security increased in 8%16.
Comparing urban with rural households it was observed that the lower food restriction in rural location is probably related to food production for self-consumption, and lower spending on non-food items such as housing, transportation, clothing, purchase of vehicles, health care, and home maintenance. In the Household Budget Survey (POF) 2008-200917 it was observed that total rural expenditures represented one-tenth of urban expenditure. It was also observed that housing expenses were much higher than food expenses in urban areas (36 vs 18.8%) than in rural ones (29.5 vs 26.5%)17. The non-monetary expenses, those obtained through own production, hunting, fishing, gathering, exchange, donation or business withdrawal, reached 20.8% in rural areas while in urban areas was 14.7%17.
It also contributes to the urban/rural differences, the family composition, such as having elderly member and younger than 18 years. As noted by a study with an urban population in Campinas18, households with elderly residents benefit from their income, from pensions, as well as the benefits from income transfer programs19. In urban areas the risk of MSFI increased in households without elderly. Children less than 18 years in urban areas represent a higher expenditure on food and non-food items. Probably the higher risk of MSFI in urban households headed by a person 45 years or more is related to the greater difficulty of remaining employed19, while another study of PNAD-2004 noted the highest unemployment (16.8%) and lowest proportion of formal work contract among the population with the lowest tenth of per capita monthly household income20. It is noteworthy that, considering only poor population, inequality is still evident and it is related to self-referred color, as described by Pinheiro et al.19, these differences are greater when the home lacks in refrigerator, washing machine, TV and telephone.
In relation to gender differences, it is important to point out that even though household appliances integrate the feminine symbolic space12, the greater lack of these items on female-headed households may point out to the existence of higher responsibility toward the cost of maintaining the equipment or, less debt capacity to acquire them.
Core families, or arrangements with few residents, though they may have lower total household income, generally they have higher resources for food. In this study, was observed a higher risk of MSFI in households with six or more residents in both urban and rural areas. The vulnerability of large families or extended with aggregates, was also observed by Torres et al.11.
Panigassi et al.21 suggested the possibility of using the direct measure of food security assessed by EBIA to complement social indicators and identify groups with social vulnerability. To the traditional indicators, it was added, in this study, the possession of some specific home appliances.
Gender inequality is marked by food restriction of female-headed households, being higher in households that do not have the specific home appliances studied. Even within a poor population, households with a per capita monthly income of less than ¼ of MW had higher MSFI prevalence and even higher among female-headed households. Although income inequality is the most important factor in determining food restriction, low schooling and being black contributed to differences in MSFI. Still other conditions that contribute to inequalities in access to food are: living in urban areas and large size family. By stratifying households by gender and skin color of heads of household the MSFI inequality is more evident. Households with a refrigerator and white male-headed had the lowest restriction and those without a refrigerator and headed by black women the highest. White female-headed households and those headed by black men had a similar condition of food restriction. Among the four groups of households, low income was the condition of greatest risk for MSFI and in all groups the risk of food restriction related to lack of refrigerator was also noteworthy.
The use of household goods individually, enabled more detailed findings than if a consumption index had been used. But when the goal is the assessment of socioeconomic status and analysis of food security conditions, the use of an indicator of family income is still indispensable.
As noted by Panigassi et al.22 and Salles-Costa et al.9 households in food insecurity have a reduced consumption of fruits, vegetables and meats. Thus the income has the explanatory power of FI and could not be otherwise since the Brazilian society is very monetized and, most of the questions in EBIA inquire the situation of food restriction related to lack of money.
It was not confirmed, based on data from PNAD 2004, that household goods that represent an operation cost or monthly expenses would compete with the purchase of food and thus would be associated with MSFI. Rather, it was the absence of specific appliances that was associated with this condition and reflects the current and past poverty situation of these families.
It can thus be assumed that, in general, the consumption behavior of poor people gives priority to food and other essential needs. Precarious socioeconomic conditions are associated with food insecurity in households, and the situation is worsened in those headed by women and people self-reported as black. The absence of household goods identifies, among the poor, the most vulnerable population to food insecurity and may constitute an additional indicator, mainly in local studies, where there is shortage of technical resources for data collection and more sophisticated analysis.
L. Marín-León developed and wrote the body of this article. P.M.S.B. Francisco, designed and performed the statistical analysis and participated in the final revisions. A.M. Segall-Corrêa and G. Panigassi participated in the review of the various versions of the article. None of the authors presented conflict of interest related to the topic discussed.
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Correspondência: Submitted on: 18/02/2010 Trabalho realizado
no Departamento de Medicina Preventiva e Social da Faculdade de Ciências
Médicas da Universidade Estadual de Campinas - Campinas (SP), Brasil.
Rua dos Alecrins 234 apto. 62 - Cambui
CEP: 13024-410 - Campinas (SP), Brasil
E-mail : firstname.lastname@example.org
Final version presented on: 30/01/2011
Accepted on: 28/02/2011
Conflito de interesse: nada a declarar.
Fonte de financiamento: nenhuma.
Submitted on: 18/02/2010
Trabalho realizado no Departamento de Medicina Preventiva e Social da Faculdade de Ciências Médicas da Universidade Estadual de Campinas - Campinas (SP), Brasil.