Abstract
BACKGROUND: Urbanization influences food systems and food security, but research on these associations in low- and middle-income countries remain limited, partly because of the binary and unstandardized "urban compared with rural" classifications. OBJECTIVES: To develop a community urbanicity scale, to assess its associations with household food security, and to explore whether agricultural occupation modifies this relationship across the 3 agroecological zones (mountain, hill, Tarai) of Nepal. METHODS: Data came from a nationally and agroecologically representative, multistaged 2013 agri-food system survey of 4285 households with children <5 y in 63 communities (wards) in Nepal. A novel community-level urbanicity scale was constructed using factor analysis that included 8 domains. Multilevel mixed effects logistic regression was used to assess associations between urbanicity and household food security (measured using the validated Household Food Insecurity Access Scale), and to investigate modifying effects of agricultural occupation. RESULTS: Urbanicity scores ranged between 13 and 69, of a possible 80 points. Most agricultural households in the mountains (67%) and hills (54%) were categorized food insecure. Increases in urbanicity were negatively associated with food insecurity, controlling for other factors (odds ratio [OR] per 10-unit urbanicity difference OR: 0.82; confidence interval [CI]: 0.71, 0.94; P ≤ 0.05). Agricultural occupation may have positively influenced this association though was not a statistically significant effect measure modifier (P = 0.07). CONCLUSIONS: The novel scale shows more nuance within Nepal's agroecological zones, which had similar urbanicity-to-food security relationships as well as overlapping urbanicity score distributions. Research and policy efforts should consider using scales providing more precise urbanicity measurement, and thus informative assessments on its role in predicting food insecurity, especially in agriculturally reliant populations.