Household food insecurity in small municipalities in Northeastern Brazil: a validation study

The State of Paraiba in Northeastern Brazil ranks as the fourth poorest state in the country. The objectives of this study are to conduct the psychometric validation of the Brazilian Household Food Insecurity Scale (EBIA), to assess the household food insecurity (HFI) prevalence, and to identify the association between HFI, poverty and dietary intake in a representative sample of Paraiba's 14 poorest municipalities (N = 4533). All municipalities included had fewer than 50,000 inhabitants. EBIA had strong internal consistency (Cronbach's alpha = 0.93 and 0.90 in households with and without children, respectively). The percentage of affirmative responses for each item was inversely associated with household income and the item curves were parallel across socio-economic strata. Rasch modeling indicated that: a) scale items severities followed theoretical expectations, b) all items had an adequate fit to the scale confirming its unidimensionality, and c) items 'functioned' similarly across key subpopulation characteristics including: urban/rural; men/women; younger/older; poor/less poor; Bolsa Familia enrollment (yes/no). HFI prevalence was higher in rural than in urban areas (55.5 % vs. 49.9 %, p < 0.0005) and severe food insecurity was substantially higher in rural areas (14.0 % vs. 9.0 %, p < 0.0005). HFI severity was inversely associated with household income, positively associated with daily sugar consumption and inversely associated with daily consumption of bread and nutrient dense foods (fruits, vegetables, and dairy). In conclusion, EBIA had strong internal and external validity at the municipal level. Findings are particularly relevant for Brazil where 89.1 % of municipalities (4,957 out of 5,565 municipalities) have less than 50,000 inhabitants.