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Washington State University Health Sciences Spokane

Q&A with Cassandra Nikolaus

Published July 16, 2021, by Judith Van Dongen

Portrait image of Cassandra NikolausA research assistant professor in the Elson S. Floyd College of Medicine, Cassandra Nikolaus conducts research focused on food security within the WSU Institute for Research and Education to Advance Community Health (IREACH). Her journey into academia took her from her local community college in Everett, Washington, to Central Washington University, where she studied nutrition and dietetics and became the first in her family to earn a bachelor’s degree. She then completed her graduate studies at the University of Illinois Urbana-Champaign before accepting a position as a postdoctoral research associate at WSU in 2019.

What drew you to WSU?
I was particularly interested in working for WSU as the state’s land grant institution, with the teaching, research, and Extension arms complementing each other. I believe that the knowledge generated by researchers should not just be in journals and only benefit other academics. Bringing that research to practice is a really important part of my ethos. Besides that, my mentor Ka’imi Sinclair [an associate professor within IREACH Ed.] has been a great advocate for all of my interests and has really taken me under her wing to ensure that I am successful here. I am really excited to be a part of WSU.

What fueled your passion to do research on food security?
As the youngest of four children raised by a single mother, I experienced food insecurity growing up. However, it was not until I was at Central Washington University as a student who was actively receiving SNAP benefits to supplement my food budget that I even learned the terminology for it. I was really interested in helping people eat healthfully despite barriers such as income or rural access issues. Having caught the research bug, I realized that by doing research in the area of food security I could make a difference for households and families experiencing some of the same challenges I had lived through.

How common is food insecurity and what are the consequences?
Though it varies based on the state of the economy, the U.S. Department of Agriculture estimates that about one in nine U.S. households experience food insecurity. Food insecurity is related to both poor physical and mental health, including increased risk of depression, diabetes, and obesity.

What are some of the challenges your research addresses?
About one in every four households led by American Indians or Alaska Natives experiences food insecurity. Yet in the annual report published by the U.S. Department of Agriculture on household food security, American Indians and Alaska Natives are lumped together with other racial and ethnic groups in this “Other” category. This practice disregards the vast differences between these groups and makes American Indians and Alaska Natives invisible in our larger political discussions of solutions to address food insecurity. It is why a lot of my work has been looking to increase what we know about food insecurity among American Indians and Alaska Natives to advocate for their continued disaggregation in reports like this. However, it is important to recognize that even when broken out separately this category of American Indians and Alaska Natives is still extremely diverse, representing more than 600 recognized tribes spread out across both rural and urban areas throughout the U.S.

You recently received a three-year mentored career development award from the Institute for Translational Health Sciences. What does that grant entail?
Healthcare providers increasingly recognize food security as playing an important role in health, but whether or not they are screening for it and implementing it into their care practice is still not well understood. This new grant will help me gain the skills to complete a research project that looks at the use and implementation of food security screening in more than 600 community health centers nationwide based on electronic health records maintained by OCHIN, a national nonprofit health IT organization. In collaboration with Dr. Rachel Gold, lead research scientist at OCHIN, I will be looking for variations in screening practices across clinics, providers, patients, and types of visits.

What advantages does food security screening in healthcare settings offer?
Integrating food security screening into the healthcare system ensures the proximity of food security information to robust health information. It allows healthcare providers to consider patients’ food insecurity when making care recommendations and refer patients to external services for food assistance. It can also help them clearly see whether alleviating food insecurity has an impact on their patients’ health. Plus, in pediatric care it can help catch food insecurity sooner. That is important, because we know that food insecurity experiences in childhood or young adulthood can potentially have ramifications later in life.

What other projects are you working on?
I am wrapping up a one-year pilot project in which I analyzed existing data to look at food insecurity in young adulthood and how it related to cardiometabolic health outcomes—such as glucose maintenance, body weight, and blood pressure—when study participants were assessed again in middle age.

I am also working on a two-year pilot project that looks at how food security relates to alcohol use among American Indian and Alaska Native parents and the social emotional development of their children. This is based on an existing data set that will allow me to see whether food insecurity predates problematic alcohol use or vice versa.

Finally, I will be evaluating how a set of food security-related survey questions used as part of the annual National Health Interview Survey performs when we specifically analyze American Indian and Alaska Native respondents. The outcome could either help us build a case for disaggregating American Indian and Alaska Native-led households in the annual report from USDA or demonstrate the need to modify the survey questions to better account for food-related cultural practices and norms that are unique to this group.

What do you hope to accomplish with your research in the long term?
My real hope is that my research career will help bridge the gap between what we know and what we do about food insecurity in this country. I would love to see my work lead to new programs and policies to mitigate some of these long-term health outcomes of food insecurity and ultimately prevention of food insecurity experiences for individuals in the U.S. across the lifespan.

This interview has been edited and condensed for clarity.