Abstract
Objectives
The objectives of this study were to examine whether food insecurity is associated with sexual risk taking and victimization in young people (aged 16–24); and to investigate whether the relationship of food insecurity with sexual risk taking and victimization is moderated by gender.
Methods
Cross-sectional data were obtained in 2014 from a sample of Ghanaian adolescents (n = 773) and in 2015 from young South African adults (n = 823). We used multilevel logistic regression given the study’s binary outcome and clustered data. We tested a moderation effect of gender by including an interaction between gender and food insecurity.
Results
Food insecurity was highly prevalent (72% in Ghana and 83% in South Africa). Food insecurity was significantly associated with unwanted sexual contact among Ghanaian adolescents (OR 1.05, 95% CI 1.02, 1.08) and age-disparate sex among young South African adults (OR 1.03, 95% CI 1.00, 1.06). Results indicated no moderating effect of gender.
Conclusions
Our findings underscore the importance of food access on young people’s sexual health, regardless of gender. Prevention efforts may be more relevant when integrated with food security interventions that target vulnerable adolescents and young adults, irrespective of gender.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Amarnani ED, Nandi A, Melgar-Quinonez H (2017) Food insecurity in the global youth: an analysis of income-related inequalities. FASEB J 31:312.5
Baer TE, Scherer EA, Fleegler EW, Hassan A (2015) Food insecurity and the burden of health-related social problems in an urban youth population. J Adolesc Health 57:601–607. https://doi.org/10.1016/j.jadohealth.2015.08.013
Banerjee A, Duflo E, Goldberg N et al (2015) A multifaceted program causes lasting progress for the very poor: evidence from six countries. Science. https://doi.org/10.1126/science.1260799
Beauclair R, Kassanjee R, Temmerman M et al (2012) Age-disparate relationships and implications for STI transmission among young adults in Cape Town, South Africa. Eur J Contracept Reprod Health Care 17:30–39. https://doi.org/10.3109/13625187.2011.644841
Belachew T, Lindstrom D, Gebremariam A et al (2013) Food insecurity, food based coping strategies and suboptimal dietary practices of adolescents in Jimma zone Southwest Ethiopia. PLoS ONE 8:e57643. https://doi.org/10.1371/journal.pone.0057643
Bowen G, Rose R, Bowen N (2005) The reliability and validity of the School Success Profile. Xlibris Corporation, Bloomington
Bruening M, Argo K, Payne-Sturges D, Laska MN (2017) The struggle is real: a systematic review of food insecurity on postsecondary education campuses. J Acad Nutr Diet 117:1767–1791. https://doi.org/10.1016/j.jand.2017.05.022
Carvajal SC, Parcel GS, Basen-Engquist K et al (1999) Psychosocial predictors of delay of first sexual intercourse by adolescents. Health Psychol 18:443–452. https://doi.org/10.1037/0278-6133.18.5.443
Chen G, Gully SM, Eden D (2001) Validation of a new general self-efficacy scale. Organ Res Methods 4:62–83
Chowa G, Masa R, Osei-Akoto I et al (2015) Impacts of financial inclusion on youth development: findings from the Ghana YouthSave experiment. Washington University, Center for Social Development, St. Louis
Chung RJ, English A (2015) Commercial sexual exploitation and sex trafficking of adolescents. Curr Opin Pediatr 27:427–433. https://doi.org/10.1097/MOP.0000000000000242
Coates J, Swindale A, Bilinsky P (2007) Household Food Insecurity Access Scale (HFIAS) for measurement of food access: indicator guide. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, DC
Cohn LD, Macfarlane S, Yanez C, Imai WK (1995) Risk-perception: differences between adolescents and adults. Health Psychol 14:217–222
Cordeiro LS, Wilde PE, Semu H, Levinson FJ (2012) Household food security is inversely associated with undernutrition among adolescents from Kilosa, Tanzania. J Nutr 142:1741–1747. https://doi.org/10.3945/jn.111.155994
Eaton LA, Cain DN, Pitpitan EV et al (2014) Exploring the relationships among food insecurity, alcohol use, and sexual risk taking among men and women living in South African townships. J Prim Prev 35:255–265. https://doi.org/10.1007/s10935-014-0346-3
Evan M, Risher K, Zungu N et al (2016) Age-disparate sex and HIV risk for young women from 2002 to 2012 in South Africa. J Int AIDS Soc 19:21310. https://doi.org/10.7448/IAS.19.1.21310
Fielding-Miller R, Mnisi Z, Adams D et al (2014) “There is hunger in my community”: a qualitative study of food security as a cyclical force in sex work in Swaziland. BMC Public Health 14:79. https://doi.org/10.1186/1471-2458-14-79
Food and Agriculture Organization of the United Nations [FAO] (1996) Rome declaration on world food security and world food summit plan of action. FAO, Rome
Frongillo EA, Nanama S (2006) Development and validation of an experience-based measure of household food insecurity within and across seasons in northern Burkina Faso. J Nutr 136:1409S–1419S
Ghana Statistical Service (2014) Ghana living standards survey round 6 (GLSS 6) Main Report. Ghana Statistical Service, Accra
Gillmore MR, Archibald ME, Morrison DM et al (2002) Teen sexual behavior: applicability of the theory of reasoned action. J Marriage Fam 64:885–897. https://doi.org/10.1111/j.1741-3737.2002.00885.x
Graham L, Patel L, Chowa G, et al (2016) Siyakha youth assets. Youth assets for employability: an evaluation of youth employability interventions. Baseline report. Centre for Social Development in Africa, University of Johannesburg; Johannesburg, South Africa
Hyder AA, Maman S, Nyoni JE et al (2005) The pervasive triad of food security, gender inequity and women’s health: exploratory research from sub-Saharan Africa. Afr Health Sci 5:328–334. https://doi.org/10.5555/afhs.2005.5.4.328
International Labor Organization [ILO] (2016) World employment and social outlook 2016: Trends for youth. ILO, Geneva
Jebena MG, Lindstrom D, Lachat C et al (2017) The effect of food insecurity on health status of adolescents in Ethiopia: longitudinal study. BMC Public Health 17:465. https://doi.org/10.1186/s12889-017-4406-5
Judge TA, Erez A, Bono JE (1998) The power of being positive: The relation between positive self-concept and job performance. Hum Perform 11:167–187
Kamndaya M, Kazembe LN, Vearey J et al (2015) Material deprivation and unemployment affect coercive sex among young people in the urban slums of Blantyre, Malawi: a multi-level approach. Health Place 33:90–100. https://doi.org/10.1016/j.healthplace.2015.03.001
Knueppel D, Demment M, Kaiser L (2010) Validation of the Household Food Insecurity Access Scale in rural Tanzania. Public Health Nutr 13:360–367. https://doi.org/10.1017/S1368980009991121
Lentz EC (2018) Complicating narratives of women’s food and nutrition insecurity: domestic violence in rural Bangladesh. World Dev 104:271–280. https://doi.org/10.1016/j.worlddev.2017.11.019
Luke N (2005) Confronting the “sugar daddy” stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Int Fam Plan Perspect 31:6–14
Masa R, Chowa G, Nyirenda V (2018) Chuma na Uchizi: a livelihood intervention to increase food security of people living with HIV in rural Zambia. J Health Care Poor Underserved 29:349–372. https://doi.org/10.1353/hpu.2018.0024
McCoy SI, Ralph LJ, Wilson W, Padian NS (2013) Alcohol production as an adaptive livelihood strategy for women farmers in Tanzania and its potential for unintended consequences on women’s reproductive health. PLoS ONE 8:e59343. https://doi.org/10.1371/journal.pone.0059343
Miller CL, Bangsberg DR, Tuller DM et al (2011) Food insecurity and sexual risk in an HIV endemic community in Uganda. AIDS Behav 15:1512–1519. https://doi.org/10.1007/s10461-010-9693-0
Millstein SG, Halpern-Flesher BL (2001) Perceptions of risk and vulnerability. In: Fischhoff B, Nightingale EO, Iannotta JG (eds) Adolescent risk and vulnerability. Concepts and measurement. National Academy Press, Washington, D.C, pp 15–49
Minnis AM, vanDommelen-Gonzalez E, Luecke E et al (2014) Yo Puedo–a conditional cash transfer and life skills intervention to promote adolescent sexual health: results of a randomized feasibility study in san francisco. J Adolesc Health 55:85–92. https://doi.org/10.1016/j.jadohealth.2013.12.007
Nydegger LA, DiFranceisco W, Quinn K, Dickson-Gomez J (2017) Gender norms and age-disparate sexual Relationships as predictors of intimate partner violence, sexual violence, and risky sex among adolescent gang members. J Urban Health 94:266–275. https://doi.org/10.1007/s11524-016-0068-3
Pryor L, Lioret S, van der Waerden J et al (2016) Food insecurity and mental health problems among a community sample of young adults. Soc Psychiatry Psychiatr Epidemiol 51:1073–1081. https://doi.org/10.1007/s00127-016-1249-9
Schaefer R, Gregson S, Eaton JW et al (2017) Age-disparate relationships and HIV incidence in adolescent girls and young women: evidence from Zimbabwe. AIDS 31:1461–1470. https://doi.org/10.1097/QAD.0000000000001506
Singer AW, Weiser SD, McCoy SI (2015) Does food insecurity undermine adherence to antiretroviral therapy? A systematic review. AIDS Behav 19:1510–1526. https://doi.org/10.1007/s10461-014-0873-1
Skinner E, Johnson S, Snyder T (2005) Six dimensions of parenting: a motivational model. Parent Sci Pract 5:175–235
Snijders TAB, Bosker RJ (2012) Multilevel analysis: an introduction to basic and advanced multilevel modeling. SAGE, Thousand Oaks
Stata (2017) Stata Statistical Software: Release 15. StataCorp LLC, College Station
Stoebenau K, Heise L, Wamoyi J, Bobrova N (2016) Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature. Soc Sci Med 168:186–197. https://doi.org/10.1016/j.socscimed.2016.09.023
Toska E, Cluver LD, Boyes M et al (2015) From “sugar daddies” to “sugar babies”: exploring a pathway among age-disparate sexual relationships, condom use and adolescent pregnancy in South Africa. Sex Health 12:59–66. https://doi.org/10.1071/SH14089
Toska E, Pantelic M, Meinck F et al (2017) Sex in the shadow of HIV: a systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. PLoS ONE 12:e0178106. https://doi.org/10.1371/journal.pone.0178106
UNAIDS [Joint United Nations Programme on HIV/AIDS] (2017) When women lead change happens. Women advancing the end of AIDS, UNAIDS, Geneva
Underwood C, Skinner J, Osman N, Schwandt H (2011) Structural determinants of adolescent girls’ vulnerability to HIV: views from community members in Botswana, Malawi, and Mozambique. Soc Sci Med 73:343–350. https://doi.org/10.1016/j.socscimed.2011.05.044
United Nations (2015) The world’s women 2015: trends and statistics. United Nations, Department of Economic and Social Affairs, Statistics Division, New York
Wang EA, Zhu GA, Evans L et al (2013) A pilot study examining food insecurity and HIV risk behaviors among individuals recently released from prison. AIDS Educ Prev 25:112–123. https://doi.org/10.1521/aeap.2013.25.2.112
Weiser SD, Leiter K, Bangsberg DR et al (2007) Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med 4:1589–1597. https://doi.org/10.1371/journal.pmed.0040260
Weiser SD, Young SL, Cohen CR et al (2011) Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr 94:1729s. https://doi.org/10.3945/ajcn.111.012070
Wong NT, Zimmerman MA, Parker EA (2010) A typology of youth participation and empowerment for child and adolescent health promotion. Am J Community Psychol 46:100–114. https://doi.org/10.1007/s10464-010-9330-0
World Health Organization, U.S. Centers for Disease Control and Prevention (n.d.) Global school-based student health survey. WHO; CDC, Geneva; Atlanta, Georgia
Zakaras JM, Weiser SD, Hatcher AM et al (2017) A qualitative investigation of the impact of a livelihood intervention on gendered power and sexual risk behaviors among HIV-positive adults in rural Kenya. Arch Sex Behav 46:1121–1133. https://doi.org/10.1007/s10508-016-0828-x
Zembe YZ, Townsend L, Thorson A, Ekström AM (2013) “Money talks, bullshit walks” interrogating notions of consumption and survival sex among young women engaging in transactional sex in post-apartheid South Africa: a qualitative enquiry. Glob Health 9:28. https://doi.org/10.1186/1744-8603-9-28
Funding
The Ghana study used data from the YouthSave project, which was funded by the MasterCard Foundation. The South Africa study used data from the Siyakha project, which was funded by the Ford Foundation, the Jobs Fund of South Africa, and the National Youth Development Agency of South Africa.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Additional information
This article is part of the special issue “Adolescent transitions”.
Rights and permissions
About this article
Cite this article
Masa, R., Graham, L., Khan, Z. et al. Food insecurity, sexual risk taking, and sexual victimization in Ghanaian adolescents and young South African adults. Int J Public Health 64, 153–163 (2019). https://doi.org/10.1007/s00038-018-1155-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00038-018-1155-x